Cytomegalovirus infection after liver transplantation incidence, risks, and benefits of prophylaxis.
BACKGROUND
Cytomegalovirus (CMV) infection and related disease is a feared complication after liver transplantation. Antiviral prophylaxis is recommended in clinical practice guidelines depending on the CMV status of both donor and recipient as well as the individual risk profile.


METHODS
We retrospectively analyzed 211 liver transplant recipients with respect to the incidence of CMV infection after transplantation, the influence of donor and recipient CMV status, and the effect of antiviral prophylaxis. In addition, the underlying liver disease and immunosuppressive regimen were compared with the incidence of CMV infection. Patients were divided into 4 groups according to CMV donor/recipient (D/R) profile: group A (D-/R-) 28 patients (13.3%), group B (D-/R+) 64 patients (30.3%), group C (D+/R+) 79 patients (37.4%), and group D (D+/R-) 40 patients (19.0%).


RESULTS
CMV infection was observed in 17.9%, 29.7%, 24.1%, and 22.5% of the patients, respectively, with no significant difference in infection rates between the groups. CMV infection occurred in 5 patients (17.9%) in the presumed low-risk profile (group A), despite an antiviral prophylaxis in 4 out of these 5 patients. In contrast, CMV infection occurred in only 9/40 patients (22.5%) in the presumed high-risk profile (group D). The most frequent infection rates were found in groups B and C (R+ groups). After successful treatment of CMV infection, no recurrence was detected. Underlying liver disease or immunosuppressive protocol had no influence on CMV infection.


CONCLUSIONS
Approximately one fourth of patients will acquire CMV infection after liver transplantation independent of donor/recipient status. Surprisingly, antiviral prophylaxis does not seem to be sufficient to reduce this proportion of patients, either in presumed high-risk or in presumed low-risk situations.
Weigand
K
K
Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Germany. kilian_weigand@med.uni-heidelberg.de
Schnitzler
P
P
Schmidt
J
J
Chahoud
F
F
Gotthardt
D
D
Schemmer
P
P
Stremmel
W
W
Sauer
P
P
D000328:Adult; D000956:Antigens, Viral / Q000032:analysis; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000235:genetics; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control*; D004279:DNA, Viral / Q000235:genetics / Q000302:isolation & purification; D004359:Drug Therapy, Combination; D005260:Female; D005784:Gene Amplification; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010750:Phosphoproteins / Q000032:analysis; D016133:Polymerase Chain Reaction / Q000379:methods; D018570:Risk Assessment; D014019:Tissue Donors; D014763:Viral Matrix Proteins / Q000032:analysis
D000956:Antigens, Viral; D000998:Antiviral Agents; D004279:DNA, Viral; D007166:Immunosuppressive Agents; D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa