Delayed-onset primary CMV after liver transplantation

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Liver

Transplantation Volume 13, Issue 12

, Pages 1703 – 1709  

Published Online: 28 Nov 2007

Delayed-onset primary cytomegalovirus disease

after liver transplantation

Supha K. Arthurs,

Albert J. Eid, A. Pedersen, Ross A. Dierkhising

, Walter K. Kremers, Robin

Patel, Raymund R. Razonable

Division of Infectious Diseases, Mayo Clinic and Mayo

Clinic College

of Medicine, Rochester, MN

Abstract

Clinical practice guidelines recommend antiviral

prophylaxis to cytomegalovirus (CMV) donor-positive/recipient-negative

(D+/R-) liver transplant recipients. We assessed the

outcome of this strategy by determining the incidence, clinical features, and

risk factors of CMV disease among CMV D+/R- liver transplant recipients who

received antiviral prophylaxis. Sixty-seven CMV

D+/R- liver transplant recipients (mean age ± standard deviation: 49.5 ± 11.4

years; 75% male) received oral ganciclovir [n = 9

(13%)] or valganciclovir [n = 58 (87%)] prophylaxis

for a median duration of 92 days (interquartile

range: 91-100). No breakthrough CMV disease was

observed during antiviral prophylaxis. However,

primary CMV disease was observed in 2%, 25%, 27%, 27%, and 29% of patients at

1, 3, 6, 12, and 24 months, respectively, after antiviral prophylaxis was

stopped. The incidence of delayed-onset primary CMV

disease was similar between those who received oral ganciclovir

and valganciclovir. Nine

(47%) patients had CMV syndrome, 8 (42%) had gastrointestinal CMV disease,

and 2 (11%) had CMV hepatitis. Female patients (P = 0.01) and younger age at transplant

(P = 0.03) were associated with

an increased risk, whereas diabetes mellitus (P < 0.001) was significantly associated with a lower

risk of delayed-onset primary CMV disease. Allograft

loss or mortality occurred in 8 (12%) patients during the median follow-up

period of 3.31 (range: 0.8-5.9) years. No

significant association was observed between CMV disease and patient and

allograft survival. In conclusion, CMV disease

remains a common complication in CMV D+/R- liver transplant patients during

the contemporary era of antiviral prophylaxis. Female

patients and younger patients are at increased risk of delayed-onset primary

CMV disease.

Liver Transpl 13:

1703-1709, 2007. © 2007 AASLD.

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