title: Early and delayed onset cytomegalovirus infection of liver transplant recipients in endemic areas.
abstract: BACKGROUND
  The delayed onset of cytomegalovirus (CMV) infection after liver transplantation can place patients at risk for graft failure and mortality.
  
  
  METHODS
  We compared early versus delayed onset of CMV infection to identify risk factors for mortality among liver transplant recipients in an endemic area.
  
  
  RESULTS
  Among 710 consecutive adult liver transplant recipients, incidence of CMV infection was 47.5% (337/710). Male gender, biliary complications, acute rejection episodes, antilymphocyte antibodies high hemoglobin, and high total bilirubin were significantly different among patients with delayed versus early onset CMV infections. The overall incidence of early versus delayed CMV infections was 43.1% (306/710) versus 4.4% (31/710). Among them, 11.1% (34/306) and 25.8% (8/31) of patients developed CMV disease.
  
  
  CONCLUSIONS
  These results showed that a higher proportion of patients developed disease among delayed CMV infected patients (P=.039). The overall and graft survival curves for patients with early onset CMV infections were better than those of patients who had delayed onset CMV infections (P=.026 and P=.014). Recurrence of hepatitis B virus, hepatic dysfunction, and retransplantation were associated with increased mortality among patients who had a delayed CMV infection.
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: J M
authors.initials: JM
authors.lastname: Kim
authors.forename: S J
authors.initials: SJ
authors.lastname: Kim
authors.forename: J-W
authors.initials: JW
authors.lastname: Joh
authors.forename: C H D
authors.initials: CH
authors.lastname: Kwon
authors.forename: M
authors.initials: M
authors.lastname: Shin
authors.forename: E Y
authors.initials: EY
authors.lastname: Kim
authors.forename: J I
authors.initials: JI
authors.lastname: Moon
authors.forename: G O
authors.initials: GO
authors.lastname: Jung
authors.forename: G S
authors.initials: GS
authors.lastname: Choi
authors.forename: S K
authors.initials: SK
authors.lastname: Lee
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D019353:Endemic Diseases / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006509:Hepatitis B / Q000601:surgery; D006526:Hepatitis C / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012727:Sex Characteristics; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors
chemical_list: D000998:Antiviral Agents