ORIGINAL ARTICLEEffect of Antiviral Chemoprophylaxis on Adverse Clinical Outcomes Associated With Cytomegalovirus After Liver Transplantation
Section snippets
PATIENTS AND METHODS
This study was approved by the Mayo Foundation Institutional Review Board. One hundred ninety-three consecutive patients undergoing their first liver transplantation between February 1998 and July 2000 at the Mayo Clinic in Jacksonville, Fla, were followed up to retransplantation, to death, or to survival at 1 year, whichever occurred first. Patients were divided into 4 groups by CMV serology of donor and recipient: donor-/recipient-; donor-/recipient+; donor+/recipient+; and donor+/recipient-.
RESULTS
Characteristics that are typically associated with infection and with death before, during, and after liver transplantation are shown in Table 1. These characteristics were analyzed for differences between groups of CMV serologies. The fresh-frozen plasma requirements were lower in the CMV donor-/recipient-group (median, 6.5 vs 10-12 units, P=.006), and greater platelet transfusion requirements were observed in the CMV donor-/recipient- and CMV donor+/recipient+ groups (median, 12 vs 6 units, P
DISCUSSION
The risk of CMV infection and disease is greatest during the first 3 months after liver transplantation, when immunosuppressive therapy is routinely the most intense.5 Independent of immunosuppression, CMV-seronegative patients who receive an allograft from CMV-seropositive donors (donor+/recipient-) are at the highest risk for CMV infection and disease.5 Recognition of these risks has directed methods for prevention and early detection of CMV infection after transplantation.
In our cohort,
CONCLUSION
The adverse consequences previously associated with CMV serology after liver transplantation are decreased in the current era of transplantation when comprehensive antiviral chemoprophylaxis is used. Identifying the effects of CMV on clinical outcomes after liver transplantation will be more difficult to discern in the presence of antiviral chemoprophylaxis.
REFERENCES (18)
- et al.
Risk factors for cytomegalovirus and severe bacterial infections following liver transplantation: a prospective mutivariate time-dependent analysis [published correction appears in J Hepatol. 1993;19:325]
J Hepatol
(1993) - et al.
The independent role of cytomegalovirus as a risk factor for invasive fungal disease in orthotopic liver transplant recipients
Am J Med
(1997) - et al.
Randomised trial of efficacy and safety of oral ganciclovir in the prevention of cytomegalovirus disease in liver-transplant recipients [published correction appears in Lancet. 1998;351:454]
Lancet
(1997) - et al.
CDC definitions for nosocomial infections, 1988 [published correction appears in Am J Infect Control. 1988;16:177]
Am J Infect Control
(1988) - et al.
Cytomegalovirus prophylaxis and graft outcome in solid organ transplantation: a collaborative transplant study report
Am J Transplant
(2004) - et al.
Does cytomegalovirus status influence acute and chronic rejection in heart transplantation during the ganciclovir prophylaxis era?
J Heart Lung Transplant
(2003) - et al.
Effect of cytomegalovirus infection status on first-year mortality rates among orthotopic liver transplant recipients
Ann Intern Med
(1997) - et al.
Significance of cytomegalovirus for long-term survival after orthotopic liver transplantation: a prospective derivation and validation cohort analysis
Transplantation
(1998) - et al.
Association of cytomegalovirus genotype with graft rejection after liver transplantation
Transplantation
(1998)
Cited by (18)
Rates of first infection following kidney transplant in the United States
2009, Kidney InternationalCitation Excerpt :Dharnidharka et al.20 also described higher hospitalized viral and bacterial infection rates among recipients of CMV-antibody-positive donors. Other authors have reported an association between donor CMV seropositivity and fungal and bacterial outcomes in liver transplantation.52–57 Nicols et al.58 found an association between donor CMV seropositivity and fungal infections in stem cell transplantation.
Pneumonia in Solid Organ Recipients: Spectrum of Pathogens in 217 Episodes
2009, Transplantation ProceedingsCitation Excerpt :Trimethoprim/sulfamethoxazole (TMPS) was given per protocol from day 2 posttransplantation for 1 year at a dose of 800 mg/160 mg two times per week. Patients at risk for CMV infection/disease received ganciclovir prophylaxis for 100 days.14 Pneumonia was defined as a new infiltrate on radiological examination together with clinical signs and symptoms of infection (elevated temperature, elevated WBC) and/or clinical symptoms, such as cough, increased bronchial secretions, dyspnea, or chest pain.15
Cytomegalovirus-Induced Polyarteritis Nodosa in a Liver Transplant Recipient
2017, American Journal of TransplantationSolid organ recipients are at increased risk for recurrent Clostridium difficile colitis
2014, European Surgery - Acta Chirurgica AustriacaThe association between cytomegalovirus immune globulin and long-term recipient and graft survival following liver transplantation
2012, Transplant Infectious DiseaseAssociation of cytomegalovirus infection and disease with death and graft loss after liver transplant in high-risk recipients
2011, American Journal of Transplantation