title: Indirect outcomes associated with cytomegalovirus (opportunistic infections, hepatitis C virus sequelae, and mortality) in liver-transplant recipients with the use of preemptive therapy for 13 years.
abstract: BACKGROUND
  The effect of preemptive therapy on indirect sequelae associated with cytomegalovirus (CMV) in liver-transplant recipients has not been clearly delineated.
  
  
  METHODS
  Thirteen years of outcome with the use of preemptive therapy were assessed in a cohort of 216 consecutive liver-transplant recipients.
  
  
  RESULTS
  The incidence of major infections (31% vs. 44.3%), bacterial infections (31% vs. 39.2%), bacteremia (19% vs. 29.1%), or fungal infections (3.4% vs. 7.6%) did not differ significantly for patients with CMV infection who received preemptive therapy compared with those who never developed CMV infection and did not receive antiviral prophylaxis for CMV (P>0.20 for all variables). The rate of opportunistic infections also did not differ when patients were stratified by primary CMV infection, reactivation infection, or no CMV infection. Recurrent hepatitis C virus (HCV) hepatitis occurred in 55.6% of the patients with CMV treated with preemptive therapy and 49.8% of those without CMV infection (P>0.20). The probability of survival at 6 months, 12 months, 2 years, and 3 years was also comparable for the two groups.
  
  
  CONCLUSIONS
  Liver-transplant recipients with CMV infection, including high-risk R-/D+ patients, when followed using the preemptive therapy approach had no significant difference in meaningful outcomes such as opportunistic superinfections, HCV recurrence rates, rejection, and survival when compared with the patients in whom CMV infection never developed and who did not receive antiviral prophylaxis for CMV.
authors.affiliation: Veterans Affairs Medical Center, Infectious Disease Section, Pittsburgh, PA 15240, USA. nis5+@pitt.edu
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
authors.forename: Cheryl
authors.initials: C
authors.lastname: Wannstedt
authors.forename: Lois
authors.initials: L
authors.lastname: Keyes
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Wagener
authors.forename: Timothy
authors.initials: T
authors.lastname: Gayowski
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Cacciarelli
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000453:epidemiology*; D012008:Recurrence; D016019:Survival Analysis; D014766:Viremia / Q000188:drug therapy
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir; D000212:Acyclovir