BACKGROUND: The incidence and impact of cytomegalovirus (CMV) disease that occurs despite CMV prophylaxis among liver transplant recipients have been incompletely defined. METHODS: The incidence and risk factors for CMV disease during the first posttransplant year in a cohort of liver transplant recipients who received antiviral prophylaxis with oral ganciclovir were retrospectively analyzed using Cox proportional-hazard regression models. RESULTS: CMV disease developed in 19 of 259 recipients (7% [95% confidence interval 0.04-0.11]) at a median of 4.5 months posttransplant, included syndrome (63%) or tissue-invasive disease (37%), and was independently associated with an increased risk of mortality during the first posttransplant year (hazard ratio 14 [95% confidence interval 3.8-54], P=0.0007). The incidence was higher (10/38 [26%] vs. 8/180 [4.5%], P<0.0001) in seronegative recipients (R-) of an organ from a seropositive donor (D+) compared with seropositive (R+) patients, respectively. D+R- status was the only variable significantly associated with CMV disease in multivariate analysis. CONCLUSIONS: Late CMV disease develops in a substantial proportion of D+R- recipients after prophylaxis is discontinued, is not accurately predicted by patient factors, and is associated with increased mortality. New strategies to identify D+R- patients at risk and to reduce the incidence and impact of late CMV disease in this group are warranted.
BACKGROUND: The incidence and impact of cytomegalovirus (CMV) disease that occurs despite CMV prophylaxis among liver transplant recipients have been incompletely defined. METHODS: The incidence and risk factors for CMV disease during the first posttransplant year in a cohort of liver transplant recipients who received antiviral prophylaxis with oral ganciclovir were retrospectively analyzed using Cox proportional-hazard regression models. RESULTS:CMV disease developed in 19 of 259 recipients (7% [95% confidence interval 0.04-0.11]) at a median of 4.5 months posttransplant, included syndrome (63%) or tissue-invasive disease (37%), and was independently associated with an increased risk of mortality during the first posttransplant year (hazard ratio 14 [95% confidence interval 3.8-54], P=0.0007). The incidence was higher (10/38 [26%] vs. 8/180 [4.5%], P<0.0001) in seronegative recipients (R-) of an organ from a seropositive donor (D+) compared with seropositive (R+) patients, respectively. D+R- status was the only variable significantly associated with CMV disease in multivariate analysis. CONCLUSIONS: Late CMV disease develops in a substantial proportion of D+R- recipients after prophylaxis is discontinued, is not accurately predicted by patient factors, and is associated with increased mortality. New strategies to identify D+R- patients at risk and to reduce the incidence and impact of late CMV disease in this group are warranted.
Authors: Elizabeth A Reap; John Morris; Sergey A Dryga; Maureen Maughan; Todd Talarico; Robert E Esch; Sarah Negri; Bruce Burnett; Andrew Graham; Robert A Olmsted; Jeffrey D Chulay Journal: Vaccine Date: 2007-08-30 Impact factor: 3.641
Authors: Julie H Ishida; Tracy Burgess; Michael A Derby; Pearline A Brown; Mauricio Maia; Rong Deng; Brinda Emu; Becket Feierbach; Ashley E Fouts; X Charlene Liao; Jorge A Tavel Journal: Antimicrob Agents Chemother Date: 2015-06-08 Impact factor: 5.191
Authors: Corinna La Rosa; Ajit P Limaye; Aparna Krishnan; Gideon Blumstein; Jeff Longmate; Don J Diamond Journal: Transpl Int Date: 2011-06-14 Impact factor: 3.782
Authors: Seung H Kang; Rima C Abdel-Massih; Robert A Brown; Ross A Dierkhising; Walter K Kremers; Raymund R Razonable Journal: J Infect Dis Date: 2012-01-04 Impact factor: 5.226
Authors: Julie H Ishida; Anita Patel; Aneesh K Mehta; Philippe Gatault; Jacqueline M McBride; Tracy Burgess; Michael A Derby; David R Snydman; Brinda Emu; Becket Feierbach; Ashley E Fouts; Mauricio Maia; Rong Deng; Carrie M Rosenberger; Lynn A Gennaro; Natalee S Striano; X Charlene Liao; Jorge A Tavel Journal: Antimicrob Agents Chemother Date: 2017-01-24 Impact factor: 5.191
Authors: Nina Singh; Drew J Winston; Raymund R Razonable; G Marshall Lyon; Fernanda P Silveira; Marilyn M Wagener; Terry Stevens-Ayers; Bradley Edmison; Michael Boeckh; Ajit P Limaye Journal: JAMA Date: 2020-04-14 Impact factor: 56.272