Changes in Donor and Recipient Demographic Characteristics Over Time Explain the Increasing Prevalence of the High-risk Cytomegalovirus Donor-positive/Recipient-negative Serostatus in Solid Organ Transplant Recipients.

I read with interest the publication in Transplantation by Imlay et al.1 In their elegant discussion, they question whether the changes over time, between 2000 and 2020, in the prevalence of specific demographic characteristics of solid organ transplant (SOT) donors and recipients would be sufficient to explain the statistically significant increase in the proportion of seropositive (+) cytomegalovirus (CMV) recipients, as well as the statistically significant increase, but to a lesser extent, of seropositive CMV donors, resulting in a significantly increased proportion of high-risk CMV donor-seropositive/recipient-seronegative SOTs. The National Health and Nutrition Examination surveys for CMV seroprevalence, 1988–19942 and 1999–2004,2 both showed that CMV seropositivity was independently associated with older age, female sex, foreign birthplace, low household income, high household crowding, and low household education. Summarizing the changes over time, between 2000 and 2020, in 4 demographic characteristics (age, race, gender, and US citizenship) listed in Table 2 from the publication by Imlay et al as shown in Table 1 illustrates how these changes can, in fact, explain the increasing proportion of high-risk CMV donor-seropositive/recipient-seronegative SOTs. Population-level strategies to mitigate the negative impact of CMV donor-seropositive/recipient-seronegative in SOT should thus include measures to increase the number of donors among younger, male, White, and non-US citizens. Examples of these strategies include introducing the concept of organ donation at a younger age for school children, supplying male hairdressers’ shops with fliers explaining the societal benefits of organ donation, and targeting geographic areas with high White race and non-US citizenship residence. TABLE 1. - Changes over time, between 2000 and 2020, in 4 demographic characteristics of solid organ transplant recipients and donors Recipients Demographic changes 2000–2020 Donors Younger Age Older More males = fewer females Gender fewer males = more females More Whites Race fewer Whites More US citizenship fewer