Delayed-onset primary cytomegalovirus disease after liver transplantation

Supha K. Arthurs, Albert J. Eid, Rachel A. Pedersen, Ross A. Dierkhising, Walter K Kremers, Robin Patel, Raymund R Razonable

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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.

Original languageEnglish (US)
Pages (from-to)1703-1709
Number of pages7
JournalLiver Transplantation
Volume13
Issue number12
DOIs
StatePublished - Dec 2007

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Cytomegalovirus
Liver Transplantation
Antiviral Agents
Ganciclovir
Liver
Allografts
Transplants
Gastrointestinal Diseases
Incidence
Practice Guidelines
Hepatitis
Diabetes Mellitus

ASJC Scopus subject areas

  • Surgery
  • Transplantation

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Delayed-onset primary cytomegalovirus disease after liver transplantation. / Arthurs, Supha K.; Eid, Albert J.; Pedersen, Rachel A.; Dierkhising, Ross A.; Kremers, Walter K; Patel, Robin; Razonable, Raymund R.

In: Liver Transplantation, Vol. 13, No. 12, 12.2007, p. 1703-1709.

Research output: Contribution to journalArticle

Arthurs, Supha K. ; Eid, Albert J. ; Pedersen, Rachel A. ; Dierkhising, Ross A. ; Kremers, Walter K ; Patel, Robin ; Razonable, Raymund R. / Delayed-onset primary cytomegalovirus disease after liver transplantation. In: Liver Transplantation. 2007 ; Vol. 13, No. 12. pp. 1703-1709.
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title = "Delayed-onset primary cytomegalovirus disease after liver transplantation",
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.",
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AU - Kremers, Walter K

AU - Patel, Robin

AU - Razonable, Raymund R

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AB - 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.

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