Prognostic significance and risk factors of untreated cytomegalovirus viremia in liver transplant recipients.
To study whether cytomegalovirus (CMV) viremia is a reliable marker of impending CMV disease and thus a guide for preemptive antiviral therapy, 126 consecutive liver transplant recipients were followed by routine CMV blood cultures in the absence of antiviral prophylaxis or treatment for viremia. Seventy-three patients (58%) developed CMV infections, and 36 (29%) had more than one infection episode: 29 patients (23%) had organ involvement and 45 (36%) had viremia. Within a same episode, CMV viremia was 90% sensitive and 80% specific for predicting concurrent organ involvement but preceded organ involvement in only 9 (31%) of 29 patients. In a separate analysis, untreated isolated CMV viremia in the first CMV infection episode was followed by organ involvement in a subsequent episode in 9 (33%) of 28 patients, mainly in the donor-positive, recipient-negative (D+/R-) population. The results indicate that CMV viremia is not an ideal marker to guide preemptive antiviral treatment in liver transplant recipients but is a good marker in D+/R- patients.
Badley
A D
AD
Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
Patel
R
R
Portela
D F
DF
Harmsen
W S
WS
Smith
T F
TF
Ilstrup
D M
DM
Steers
J L
JL
Wiesner
R H
RH
Paya
C V
CV
D000328:Adult; D015415:Biomarkers; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000628:therapy / Q000821:virology; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014766:Viremia / Q000175:diagnosis* / Q000628:therapy / Q000821:virology
D015415:Biomarkers