Evaluation of risk factors for cytomegalovirus infection and disease occurring within 1 year of liver transplantation in high‐risk patients. Issue 2 (18th January 2013)

• Record Type: Journal Article
• Authors: Katsolis, J.G.; Bosch, W.; Heckman, M.G.; Diehl, N.N.; Shalev, J.A.; Pungpapong, S.; Gonwa, T.A.; Hellinger, W.C.
• Is Part Of: Transplant infectious disease. Volume 15:Issue 2(2013)
• Page Start: 171
• Page End: 180
• Publication Date: 2013-01-18
• Subjects: Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.12050
• Languages: English
• ISSNs: 1398-2273

Abstract

<abstract abstract-type="main" id="tid12050-abs-0001"> <title>Abstract</title> <sec id="tid12050-sec-0001" sec-type="section"> <title>Background</title> <p>Recent studies have demonstrated that cytomegalovirus (CMV) infection and disease are associated with increased risk of graft loss and death in high‐risk (donor CMV seropositive/recipient CMV seronegative) liver transplant recipients (LTR) despite effective antiviral chemoprophylaxis. Predictors of CMV infection and disease in this important population are incompletely defined.</p> </sec> <sec id="tid12050-sec-0002" sec-type="section"> <title>Methods</title> <p>A retrospective cohort study of 227 high‐risk first LTR who received primary anti‐CMV chemoprophylaxis during the first 100 days after transplant was performed. A large number of patient, donor, operative, and post‐transplant potential risk factors were collected. Associations of potential risk factors for CMV infection or disease that occurred during the first year after transplant were assessed using Cox regression models. After Bonferroni adjustment for multiple testing, <italic>P</italic>‐values ≤0.00125 (associations with CMV infection) and ≤0.00122 (associations with CMV disease) were considered as statistically significant.</p> </sec> <sec id="tid12050-sec-0003" sec-type="section"> <title>Results</title> <p>CMV infection and disease occurred in 91 (40%) and 43 (19%) of LTR, respectively. In multivariable analysis, increased risk of CMV infection was observed for patients with lower model for end‐stage liver disease (MELD) score (<italic>P</italic> = 0.025), lower total bilirubin (<italic>P</italic> = 0.014), and longer operative time (<italic>P</italic> = 0.038), whereas increased risk of CMV disease was seen in patients with lower MELD score (<italic>P</italic> = 0.026), lower total bilirubin (<italic>P</italic> = 0.044), and lower international normalized ratio (<italic>P</italic> = 0.043). However, after adjustment for multiple testing, none of these findings approached statistical significance.</p> </sec> <sec id="tid12050-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Our results suggest that interventions designed to prevent CMV infection and disease should be applied to all high‐risk LTR until more definitive predictors of these complications are identified.</p> </sec> </abstract>