The clinical impact of ganciclovir prophylaxis on the occurrence of bacteremia in orthotopic liver transplant recipients.
BACKGROUND
Cytomegalovirus (CMV) infection or receipt of a CMV-seropositive donor liver has been shown to be an independent predictor of bacteremia in orthotopic liver transplant (OLT) recipients. However, prevention of CMV infection through use of intense CMV prophylaxis has not been examined to assess the impact on bacteremia in liver transplant recipients.


METHODS
We analyzed the impact of CMV prophylaxis on rates of bacteremia by examining 192 consecutive OLT recipients during a 2-year follow-up period.


RESULTS
There were 29 episodes of bacteremia. Univariate analysis of risk factors for bacteremia showed that invasive fungal disease, initial anti-lymphocyte immunosuppression, treatment for rejection, and use of solumedrol were significantly associated with increased risk. Receipt of >or=14 days of ganciclovir prophylaxis (hazard ratio [HR], 0.40; 95% CI [confidence interval], 0.18-0.87; P=.02), end-to-end biliary anastomosis, and receipt of <10 units of red blood cells (RBCs) were significantly associated with a decreased risk. Three-variable analysis controlling for end-to-end anastomosis and use of <10 units of RBCs, showed that use of >or=14 days of ganciclovir was still associated with a reduced risk of bacteremia (HR, 0.44; 95% CI, 0.20-0.98; P=.0437).


CONCLUSIONS
Among factors associated with bacteremia, use of prophylactic ganciclovir is independently associated with a significant reduction of bacteremia in OLT recipients.
Munoz-Price
L Silvia
LS
Division of Geographic Medicine and Infectious Diseases, Tufts-New England Medical Center, Tufts University, Boston, Massachusetts 02111, USA.
Slifkin
Michelle
M
Ruthazer
Robin
R
Poutsiaka
Debra D
DD
Hadley
Susan
S
Freeman
Richard
R
Rohrer
Richard
R
Angelis
Michael
M
Cooper
Jeffrey
J
Fairchild
Ralph
R
Barefoot
Laurie
L
Bloom
Judy
J
Fitzmaurice
Susan
S
Snydman
David R
DR
D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications* / Q000517:prevention & control*; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D013997:Time Factors
D000914:Antibodies, Viral; D000998:Antiviral Agents; D015774:Ganciclovir