Effect of antiviral chemoprophylaxis on adverse clinical outcomes associated with cytomegalovirus after liver transplantation.
OBJECTIVE
To assess t he association be tweencytomegalovirus (CMV) serology of donor and recipient and adverse outcomes afterliver transplantation in the era of effective antiviral chemoprophylaxis.


METHODS
We performed a retrospective cohort study of 193 consecutive patients undergoing their first liver transplantation between February 1998 and July 2000 with targeted and preemptive ganciclovir chemoprophylaxis. Patients were divided into 4 groups by CMV serology of donor and recipient: donor-/recipient-; donor-/recipient+; donor+/recipient+; and donor+/recipient-. Survival to the end points of retransplantation, death, or survival to 1 year after transplantation (whichever occurred first) was assessed. Rates of bacterial, fungal, and CMV Infection and of CMV disease were recorded and compared.


RESULTS
No significant differences were observed in the rates of retransplantation, death, or survival to 1 year among the 4 groups of patients. Despite significantly higher rates of CMV infection in the donor+ groups, there were no differences in the rates of bacterial or fungal Infection or of CMV disease. Rejection occurred least frequently in the donor-/recipient- group.


CONCLUSIONS
The adverse effects of CMV on outcomes after liver transplantation have been diminished in the era of effective antiviral chemoprophylaxis.
Hellinger
Walter C
WC
Division of Infectious Diseases, Mayo Clinic College of Medicine, 4500 San Pablo Rd, Jacksonville, FL 32224, USA. helling@mayo.edu
Bonatti
Hugo
H
Machicao
Victor I
VI
Yao
Joseph D
JD
Brumble
Lisa M
LM
Alvarez
Salvador
S
Weigand
Stephen D
SD
Dickson
Rolland C
RC
Harnois
Denise M
DM
Spivey
James R
JR
Stapelfeldt
Wolf H
WH
Hughes
Christopher B
CB
Nguyen
Justin H
JH
Steers
Jeffery L
JL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000276:immunology; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D000914:Antibodies, Viral; D000998:Antiviral Agents