Significance of cytomegalovirus for long-term survival after orthotopic liver transplantation: A prospective derivation and validation cohort analysis

Matthew E. Falagas, Carlos Paya, Robin Ruthazer, Andrew David Badley, Robin Patel, Russell Wiesner, John Griffith, Richard Freeman, Richard Rohrer, Barbara G. Werner, David R. Snydman

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Background. Cytomegalovirus (CMV) infection and diseases has been found to be found to be associated with decreased graft and patient survival among heart transplant recipients. We sought to explore the effect of CMV infection and disease on long-term survival in orthotopic liver transplant (OLT) recipients using a derivation and validation cohort. Methods. For derivation- validation modeling, we used data collected from two prospectively followed cohorts as the basis for multivariate analyses: 167 OLT recipients from the Boston Center for Liver Transplantation (the derivation set; median follow- up: 5.5 years, mortality: 40%) and an independent cohort of 294 OLT recipients from the Mayo Clinic (the validation set; median follow-up: 4.8 years, mortality: 27%). Results. Underlying liver disease other than primary biliary cirrhosis or sclerosing cholangitis, number of units of red blood cells administered during transplantation, and donor CMV seropositivity were the pre- and intratransplant variables independently associated (P < 0.01) with decreased long-term survival in the derivation cohort. For variables collected up to 1 year after transplantation, the need for retransplantation, CMV pneumonia, invasive fungal disease, and underlying liver disease other than primary biliary cirrhosis or sclerosing cholangitis were independently associated (P < 0.01) with decreased long-term survival in the derivation cohort. The magnitude of the relationship of each pre-, intra-, and posttransplant factor with survival, as measured by the relative risk, did not significantly differ between the derivation and validation cohorts. The derivation model, incorporating pre-, intra-, and posttransplant factors, had receiver operating characteristic areas of 73% and 74% for 5-year mortality in the derivation and validation cohorts, respectively. Conclusions. Data from a derivation and an independent validation cohort demonstrate that CMV factors (reflected by either donor CMV seropositivity at transplantation, CMV pneumonia, or CMV disease within the first posttransplant year) are independently associated with decreased long-term survival in OLT recipients.

Original languageEnglish (US)
Pages (from-to)1020-1028
Number of pages9
JournalTransplantation
Volume66
Issue number8
DOIs
StatePublished - Oct 27 1998
Externally publishedYes

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Cytomegalovirus
Liver Transplantation
Cohort Studies
Survival
Sclerosing Cholangitis
Biliary Liver Cirrhosis
Transplantation
Liver
Cytomegalovirus Infections
Mortality
Liver Diseases
Pneumonia
Tissue Donors
Mycoses
Graft Survival
ROC Curve
Multivariate Analysis
Erythrocytes
Transplant Recipients

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Significance of cytomegalovirus for long-term survival after orthotopic liver transplantation : A prospective derivation and validation cohort analysis. / Falagas, Matthew E.; Paya, Carlos; Ruthazer, Robin; Badley, Andrew David; Patel, Robin; Wiesner, Russell; Griffith, John; Freeman, Richard; Rohrer, Richard; Werner, Barbara G.; Snydman, David R.

In: Transplantation, Vol. 66, No. 8, 27.10.1998, p. 1020-1028.

Research output: Contribution to journalArticle

Falagas, Matthew E. ; Paya, Carlos ; Ruthazer, Robin ; Badley, Andrew David ; Patel, Robin ; Wiesner, Russell ; Griffith, John ; Freeman, Richard ; Rohrer, Richard ; Werner, Barbara G. ; Snydman, David R. / Significance of cytomegalovirus for long-term survival after orthotopic liver transplantation : A prospective derivation and validation cohort analysis. In: Transplantation. 1998 ; Vol. 66, No. 8. pp. 1020-1028.
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abstract = "Background. Cytomegalovirus (CMV) infection and diseases has been found to be found to be associated with decreased graft and patient survival among heart transplant recipients. We sought to explore the effect of CMV infection and disease on long-term survival in orthotopic liver transplant (OLT) recipients using a derivation and validation cohort. Methods. For derivation- validation modeling, we used data collected from two prospectively followed cohorts as the basis for multivariate analyses: 167 OLT recipients from the Boston Center for Liver Transplantation (the derivation set; median follow- up: 5.5 years, mortality: 40{\%}) and an independent cohort of 294 OLT recipients from the Mayo Clinic (the validation set; median follow-up: 4.8 years, mortality: 27{\%}). Results. Underlying liver disease other than primary biliary cirrhosis or sclerosing cholangitis, number of units of red blood cells administered during transplantation, and donor CMV seropositivity were the pre- and intratransplant variables independently associated (P < 0.01) with decreased long-term survival in the derivation cohort. For variables collected up to 1 year after transplantation, the need for retransplantation, CMV pneumonia, invasive fungal disease, and underlying liver disease other than primary biliary cirrhosis or sclerosing cholangitis were independently associated (P < 0.01) with decreased long-term survival in the derivation cohort. The magnitude of the relationship of each pre-, intra-, and posttransplant factor with survival, as measured by the relative risk, did not significantly differ between the derivation and validation cohorts. The derivation model, incorporating pre-, intra-, and posttransplant factors, had receiver operating characteristic areas of 73{\%} and 74{\%} for 5-year mortality in the derivation and validation cohorts, respectively. Conclusions. Data from a derivation and an independent validation cohort demonstrate that CMV factors (reflected by either donor CMV seropositivity at transplantation, CMV pneumonia, or CMV disease within the first posttransplant year) are independently associated with decreased long-term survival in OLT recipients.",
author = "Falagas, {Matthew E.} and Carlos Paya and Robin Ruthazer and Badley, {Andrew David} and Robin Patel and Russell Wiesner and John Griffith and Richard Freeman and Richard Rohrer and Werner, {Barbara G.} and Snydman, {David R.}",
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T1 - Significance of cytomegalovirus for long-term survival after orthotopic liver transplantation

T2 - A prospective derivation and validation cohort analysis

AU - Falagas, Matthew E.

AU - Paya, Carlos

AU - Ruthazer, Robin

AU - Badley, Andrew David

AU - Patel, Robin

AU - Wiesner, Russell

AU - Griffith, John

AU - Freeman, Richard

AU - Rohrer, Richard

AU - Werner, Barbara G.

AU - Snydman, David R.

PY - 1998/10/27

Y1 - 1998/10/27

N2 - Background. Cytomegalovirus (CMV) infection and diseases has been found to be found to be associated with decreased graft and patient survival among heart transplant recipients. We sought to explore the effect of CMV infection and disease on long-term survival in orthotopic liver transplant (OLT) recipients using a derivation and validation cohort. Methods. For derivation- validation modeling, we used data collected from two prospectively followed cohorts as the basis for multivariate analyses: 167 OLT recipients from the Boston Center for Liver Transplantation (the derivation set; median follow- up: 5.5 years, mortality: 40%) and an independent cohort of 294 OLT recipients from the Mayo Clinic (the validation set; median follow-up: 4.8 years, mortality: 27%). Results. Underlying liver disease other than primary biliary cirrhosis or sclerosing cholangitis, number of units of red blood cells administered during transplantation, and donor CMV seropositivity were the pre- and intratransplant variables independently associated (P < 0.01) with decreased long-term survival in the derivation cohort. For variables collected up to 1 year after transplantation, the need for retransplantation, CMV pneumonia, invasive fungal disease, and underlying liver disease other than primary biliary cirrhosis or sclerosing cholangitis were independently associated (P < 0.01) with decreased long-term survival in the derivation cohort. The magnitude of the relationship of each pre-, intra-, and posttransplant factor with survival, as measured by the relative risk, did not significantly differ between the derivation and validation cohorts. The derivation model, incorporating pre-, intra-, and posttransplant factors, had receiver operating characteristic areas of 73% and 74% for 5-year mortality in the derivation and validation cohorts, respectively. Conclusions. Data from a derivation and an independent validation cohort demonstrate that CMV factors (reflected by either donor CMV seropositivity at transplantation, CMV pneumonia, or CMV disease within the first posttransplant year) are independently associated with decreased long-term survival in OLT recipients.

AB - Background. Cytomegalovirus (CMV) infection and diseases has been found to be found to be associated with decreased graft and patient survival among heart transplant recipients. We sought to explore the effect of CMV infection and disease on long-term survival in orthotopic liver transplant (OLT) recipients using a derivation and validation cohort. Methods. For derivation- validation modeling, we used data collected from two prospectively followed cohorts as the basis for multivariate analyses: 167 OLT recipients from the Boston Center for Liver Transplantation (the derivation set; median follow- up: 5.5 years, mortality: 40%) and an independent cohort of 294 OLT recipients from the Mayo Clinic (the validation set; median follow-up: 4.8 years, mortality: 27%). Results. Underlying liver disease other than primary biliary cirrhosis or sclerosing cholangitis, number of units of red blood cells administered during transplantation, and donor CMV seropositivity were the pre- and intratransplant variables independently associated (P < 0.01) with decreased long-term survival in the derivation cohort. For variables collected up to 1 year after transplantation, the need for retransplantation, CMV pneumonia, invasive fungal disease, and underlying liver disease other than primary biliary cirrhosis or sclerosing cholangitis were independently associated (P < 0.01) with decreased long-term survival in the derivation cohort. The magnitude of the relationship of each pre-, intra-, and posttransplant factor with survival, as measured by the relative risk, did not significantly differ between the derivation and validation cohorts. The derivation model, incorporating pre-, intra-, and posttransplant factors, had receiver operating characteristic areas of 73% and 74% for 5-year mortality in the derivation and validation cohorts, respectively. Conclusions. Data from a derivation and an independent validation cohort demonstrate that CMV factors (reflected by either donor CMV seropositivity at transplantation, CMV pneumonia, or CMV disease within the first posttransplant year) are independently associated with decreased long-term survival in OLT recipients.

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