title: OKT3 treatment for allograft rejection is a risk factor for cytomegalovirus disease in liver transplantation.
abstract: The role of OKT3 monoclonal antibody administration was studied as a risk factor for symptomatic cytomegalovirus (CMV) infection in 229 consecutive liver transplant recipients not receiving specific CMV prophylaxis. Twenty-six patients (11.4%) received OKT3 and 17 of them developed CMV infection, 11 (4.8%) being symptomatic. OKT3 use was a significant risk factor for symptomatic CMV infection by both univariate (relative risk [RR], 2.9; 95% confidence interval [CI], 1.5-5.8; P = .002) and multivariate time-dependent (RR, 3.4; 95% CI, 1.7-7.1; P = .001) analyses. A subgroup analysis revealed that OKT3 use was a significant risk factor for symptomatic CMV infection in CMV-seropositive but not seronegative recipients. OKT3 therapy for steroid-resistant rejection is a risk factor for symptomatic CMV infection in liver transplant recipients who are seropositive for CMV before transplantation. This group should be targeted for antiviral prophylaxis when OKT3 antirejection therapy is used.
authors.affiliation: Department of Biostatistics, Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: D
authors.initials: D
authors.lastname: Portela
authors.forename: R
authors.initials: R
authors.lastname: Patel
authors.forename: J J
authors.initials: JJ
authors.lastname: Larson-Keller
authors.forename: D M
authors.initials: DM
authors.lastname: Ilstrup
authors.forename: R H
authors.initials: RH
authors.lastname: Wiesner
authors.forename: J L
authors.initials: JL
authors.lastname: Steers
authors.forename: R A
authors.initials: RA
authors.lastname: Krom
authors.forename: C V
authors.initials: CV
authors.lastname: Paya
mesh_terms: D003586:Cytomegalovirus Infections / Q000097:blood / Q000209:etiology*; D005260:Female; D006084:Graft Rejection / Q000628:therapy*; D006801:Humans; D007165:Immunosuppression Therapy; D016031:Liver Transplantation; D016040:Lung Transplantation; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D015999:Multivariate Analysis; D016853:Muromonab-CD3 / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D012307:Risk Factors
chemical_list: D016853:Muromonab-CD3; D008775:Methylprednisolone