Impact of cytomegalovirus in organ transplant recipients in the era of antiviral prophylaxis.
BACKGROUND
Antiviral prophylaxis has been shown to decrease the incidence of cytomegalovirus (CMV) disease in organ transplant recipients, but whether CMV disease that occurs despite prophylaxis is associated with mortality remains unknown.


METHODS
The clinical features and risk factors for CMV disease in a cohort of liver transplant recipients who received antiviral prophylaxis were assessed retrospectively. Cox proportional hazard regression was used to assess the relationship of CMV to mortality during the first posttransplant year.


RESULTS
CMV disease developed in 37 of 437 (8.5%) recipients at a median of 4.5 (range, 2.5 to 12) months posttransplant and was associated only with donor-seropositive/recipient-seronegative serostatus in multivariate analysis (P<0.0001). Mortality at 1 year was 12% (51 of 437) and was infection-associated in 49% of cases. In multivariate analysis, CMV disease was independently associated with overall mortality at 1 year (HR, 5.1, P=0.002) and even more strongly with infection-associated mortality (HR 11, P=0.002). There was no association of CMV with noninfection-associated mortality (P>0.05).


CONCLUSIONS
Late CMV disease is an important clinical problem in liver transplant recipients who receive antiviral prophylaxis, and is strongly and independently associated with mortality. Strategies to prevent late CMV disease are warranted.
Limaye
Ajit P
AP
Department of Laboratory Medicine, University of Washington, Seattle, WA 98195-7110, USA. limaye@u.washington.edu
Bakthavatsalam
Ramasamy
R
Kim
Hyung W
HW
Randolph
Sara E
SE
Halldorson
Jeffrey B
JB
Healey
Patrick J
PJ
Kuhr
Christian S
CS
Levy
Adam E
AE
Perkins
James D
JD
Reyes
Jorge D
JD
Boeckh
Michael
M
D000998:Antiviral Agents / Q000494:pharmacology*; D015331:Cohort Studies; D003587:Cytomegalovirus / Q000187:drug effects* / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000401:mortality / Q000473:pathology / Q000517:prevention & control* / Q000821:virology; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors
D000998:Antiviral Agents