title: Impact of cytomegalovirus in organ transplant recipients in the era of antiviral prophylaxis.
abstract: 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.
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, WA 98195-7110, USA. limaye@u.washington.edu
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Limaye
authors.forename: Ramasamy
authors.initials: R
authors.lastname: Bakthavatsalam
authors.forename: Hyung W
authors.initials: HW
authors.lastname: Kim
authors.forename: Sara E
authors.initials: SE
authors.lastname: Randolph
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Halldorson
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Healey
authors.forename: Christian S
authors.initials: CS
authors.lastname: Kuhr
authors.forename: Adam E
authors.initials: AE
authors.lastname: Levy
authors.forename: James D
authors.initials: JD
authors.lastname: Perkins
authors.forename: Jorge D
authors.initials: JD
authors.lastname: Reyes
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
mesh_terms: 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
chemical_list: D000998:Antiviral Agents