title: The risk factors for cytomegalovirus syndrome and tissue-invasive cytomegalovirus disease in liver transplant recipients who have cytomegalovirus antigenemia.
abstract: Cytomegalovirus (CMV) infection is not only a common complication after liver transplantation (OLT), but also a significant contributing factor to morbidity and mortality. We investigated risk factors for CMV syndrome and tissue-invasive CMV disease in CMV antigenemia patients after OLT in a CMV endemic area. CMV antigenemia was regarded to be >1 positive CMV pp65 antigen positive cell per 400,000 white blood cells. We examined the epidemiology, clinical characteristics, and laboratory findings of liver transplant patients with CMV syndrome and tissue-invasive CMV disease. The incidence of CMV syndrome among patients with CMV antigenemia was 10.5% (37/353) and that of tissue-invasive CMV disease, 3.1% (11/353). Upon multivariate analysis the risk factors for CMV syndrome and tissue-invasive CMV disease were infection, low albumin level, high total bilirubin content, and high CMV peak titer. The 1-y, 2-y, and 3-year survival rates of subjects without CMV syndrome were 96.2%, 85.4% and 82.2% versus without tissue-invasive CMV disease, 86.9%, 83.0%, and 80.1%, or 70.3%, 56.1% and 51.8% for CMV syndrome or 72.7%, 62.3%, 49.9% for tissue-invasive CMV disease. The survival curve of patients without were superior to those with CMV syndrome (P=.000). Because OLT recipients had risk factors such as infection, low albumin level, high total bilirubin content, and high CMV peak titer, they were carefully monitored and aggressively managed due to the poor survivals of patients with CMV syndrome.
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: M
authors.initials: M
authors.lastname: Shin
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: C H D
authors.initials: CH
authors.lastname: Kwon
authors.forename: S-K
authors.initials: SK
authors.lastname: Lee
mesh_terms: D000328:Adult; D000956:Antigens, Viral / Q000097:blood*; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D019353:Endemic Diseases; D005260:Female; D006526:Hepatitis C / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D017114:Liver Failure, Acute / Q000453:epidemiology / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000956:Antigens, Viral