title: Risk factors for cytomegalovirus and severe bacterial infections following liver transplantation: a prospective multivariate time-dependent analysis.
abstract: Risk factors for cytomegalovirus and severe bacterial infections were studied prospectively by univariate, multivariate and time-dependent Cox model analysis in 79 consecutive liver transplant patients treated with selective bowel decontamination. Cytomegalovirus infection occurred in 39 patients (49%) and was symptomatic in 22 patients. Twenty-six patients (33%) developed at least one of 43 documented severe bacterial infections. In a multivariate analysis of risk factors for all cytomegalovirus infections, the cytomegalovirus seronegative recipient-cytomegalovirus seropositive donor group was the highest risk group (P < 0.001). Using the same analysis for risk factors for symptomatic cytomegalovirus infections, a prolonged prothrombin time (P < 0.005), a diagnosis of acute fulminant hepatitis as the underlying liver disease (P < 0.01) and a cytomegalovirus seronegative patient receiving a liver from a seropositive donor (P < 0.001) were significant. The treatment with OKT3 therapy (P < 0.008) and hepatic artery thrombosis (P < 0.02) were found to be significant risk factors in a time-dependent univariate analysis but were not independent risk factors when multivariate analysis was utilized. Significant risk factors for major bacterial infections (P < 0.03) using univariate analysis included a prolonged anesthesia, anhepatic and surgical times, as well as the transfusion of large amounts of fresh frozen plasma or autologous blood. In a multivariate analysis, only the transfusion of large amounts of fresh frozen plasma (P < 0.04) was a significant independent risk factor. Cytomegalovirus infection was a risk factor for the development of severe bacterial infections (P < 0.03) in a multivariate time-dependent analysis.
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: C V
authors.initials: CV
authors.lastname: Paya
authors.forename: R H
authors.initials: RH
authors.lastname: Wiesner
authors.forename: P E
authors.initials: PE
authors.lastname: Hermans
authors.forename: J J
authors.initials: JJ
authors.lastname: Larson-Keller
authors.forename: D M
authors.initials: DM
authors.lastname: Ilstrup
authors.forename: R A
authors.initials: RA
authors.lastname: Krom
authors.forename: S
authors.initials: S
authors.lastname: Rettke
authors.forename: T F
authors.initials: TF
authors.lastname: Smith
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology*; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors