title: Predictive factors for cytomegalovirus infection after orthotopic liver transplantation using an ultrasensitive polymerase chain reaction assay.
abstract: The predictive factors for cytomegalovirus (CMV) infection in de novo liver transplant patients were determined at 3 months posttransplantation. We included all consecutive patients except those who died or who had lost their graft within 1 month posttransplant. We recorded both donor (D) and recipient (R) data. Immunosuppression utilized tacrolimus, steroids, with or without mycophenolate mofetil, and/or induction therapy with anti-CD25 monoclonal antibodies. CMV prophylaxis was administered only to those at high risk of CMV infection, namely, D+/R- patients. These cases received intravenous ganciclovir at 500 mg/d for the first 2 weeks followed by oral ganciclovir at 500 mg for the following 3 months. The median time to CMV infection was 1 month. The significant predictive factors for CMV infection were D/R CMV status, (P = .002): D+/R+ versus other patients (P = .01), D-/R- versus other patients (P = .002), D+ versus D- (P = .009). In addition infection was associated with the original liver disease (hepatitis C virus infection or alcohol-related cirrhosis; P = .03), R+ vs. R- (P = .03), donor age (<45 or >45 years; P = .01), lymphocyte count at M2 (< or >1300/mm(3); P = .02), hemoglobin levels at 1 and 3 months, and platelet and white blood cell counts at day 7. The independent predictive factors were recipient CMV sero-status (R+ vs R-; odds ratio = 10.2), donor age >45 years (odds ratio = 11.4) and lymphocyte count at M2 <1300/mm(3) (odds ratio = 7.33). This study showed that the major factors associated with CMV infection were recipient CMV status, donor age, and lymphocyte count.
authors.affiliation: Multiorgan Transplant Unit, University Hospital, CHU Rangueil, Toulouse, France.
authors.forename: G
authors.initials: G
authors.lastname: Basse
authors.forename: L
authors.initials: L
authors.lastname: Esposito
authors.forename: C
authors.initials: C
authors.lastname: Mengelle
authors.forename: N
authors.initials: N
authors.lastname: Kamar
authors.forename: D
authors.initials: D
authors.lastname: Ribes
authors.forename: L
authors.initials: L
authors.lastname: Lavayssière
authors.forename: A
authors.initials: A
authors.lastname: Pillet
authors.forename: B
authors.initials: B
authors.lastname: Suc
authors.forename: K
authors.initials: K
authors.lastname: Barange
authors.forename: L
authors.initials: L
authors.lastname: Rostaing
mesh_terms: D001483:Base Sequence; D003587:Cytomegalovirus / Q000235:genetics* / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000517:prevention & control*; D017931:DNA Primers; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology; D018655:Lymphocyte Count; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications / Q000821:virology*; D011237:Predictive Value of Tests; D014019:Tissue Donors
chemical_list: D017931:DNA Primers; D007166:Immunosuppressive Agents