title: Influence of cytomegalovirus disease in outcome of solid organ transplant patients.
abstract: BACKGROUND
  Despite recent advances in prevention and treatment, cytomegalovirus (CMV) is still a major complication in transplant patients. This study sought to analyze the incidence of CMV disease and its impact on patient and graft survival.
  
  
  METHODS
  Between June 2003 and December 2009, we included all kidney, liver, heart, and double transplant patients who underwent solid organ transplantation. They had 1-year posttransplant follow-up.
  
  
  RESULTS
  Among the 1427 patients who received kidney (n = 661), liver (n = 494), heart (n = 89), or double (n = 183) transplants, 103 (7.2%) displayed CMV disease. The incidence by type of transplant was: heart (n = 17, 19%), liver (n = 35, 7%), kidney (n = 41, 6.2%), or double transplant (n = 10, 5.5%; P < .001). In 59% of cases, the infection developed during the first 3 months after transplantation. CMV infections ranged from viral syndrome (n = 47, 45%) to tissue-invasive disease (n = 56, 55%), including 38% with gastrointestinal involvement. Relapsing episodes occurred in 12 patients (11%). Discordant donor/recipient CMV serology was present in 151 patients (donor positive/receptor negative), including 34 (22.5%) who developed primary CMV disease (P < .001). Coinfections mostly bacterial, were diagnosed in 38% of patients. An acute rejection episode was present in 31% of patients with CMV disease compared to 20% without this complication (P = .017). Crude mortality was significantly higher among patients with CMV disease (n = 18 patients [18%] vs 92 patients [7%]; P < .001).
  
  
  CONCLUSIONS
  Our data confirmed that CMV disease was associated with worse transplant outcomes, with higher incidences of acute rejection episodes and mortality.
authors.affiliation: Services of Infectious Diseases, Hospital Clínic, Barcelona-IDIBAPS-University of Barcelona, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Linares
authors.forename: G
authors.initials: G
authors.lastname: Sanclemente
authors.forename: C
authors.initials: C
authors.lastname: Cervera
authors.forename: I
authors.initials: I
authors.lastname: Hoyo
authors.forename: F
authors.initials: F
authors.lastname: Cofán
authors.forename: M J
authors.initials: MJ
authors.lastname: Ricart
authors.forename: F
authors.initials: F
authors.lastname: Pérez-Villa
authors.forename: M
authors.initials: M
authors.lastname: Navasa
authors.forename: M A
authors.initials: MA
authors.lastname: Marcos
authors.forename: A
authors.initials: A
authors.lastname: Antón
authors.forename: T
authors.initials: T
authors.lastname: Pumarola
authors.forename: A
authors.initials: A
authors.lastname: Moreno
mesh_terms: D000208:Acute Disease; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D005260:Female; D006084:Graft Rejection / Q000209:etiology* / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016377:Organ Transplantation / Q000009:adverse effects*; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents