Elsevier

Mayo Clinic Proceedings

Volume 81, Issue 8, August 2006, Pages 1029-1033
Mayo Clinic Proceedings

ORIGINAL ARTICLE
Effect of Antiviral Chemoprophylaxis on Adverse Clinical Outcomes Associated With Cytomegalovirus After Liver Transplantation

https://doi.org/10.4065/81.8.1029Get rights and content

OBJECTIVE

To assess the association between cytomegalovirus (CMV) serology of donor and recipient and adverse outcomes after liver transplantation in the era of effective antiviral chemoprophylaxis.

PATIENTS AND METHODS

We performed a retrospective cohort study of 193 consecutive patients undergoing their first liver transplantation between February 1998 and July 2000 with targeted and preemptive ganciclovir chemoprophylaxis. Patients were divided into 4 groups by CMV serology of donor and recipient: donor-/recipient-; donor-/recipient+; donor+/recipient+; and donor+/recipient-. Survival to the end points of retransplantation, death, or survival to 1 year after transplantation (whichever occurred first) was assessed. Rates of bacterial, fungal, and CMV infection and of CMV disease were recorded and compared.

RESULTS

No significant differences were observed in the rates of retransplantation, death, or survival to 1 year among the 4 groups of patients. Despite significantly higher rates of CMV infection in the donor+ groups, there were no differences in the rates of bacterial or fungal infection or of CMV disease. Rejection occurred least frequently in the donor-/recipient-group.

CONCLUSION

The adverse effects of CMV on outcomes after liver transplantation have been diminished in the era of effective antiviral chemoprophylaxis.

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)

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