title: Management of cytomegalovirus infection after living donor liver transplantation.
abstract: OBJECTIVE
  Few studies on Cytomegalovirus (CMV) infection in adult-to-adult living donor liver transplantation (LDLT) have been reported. The aim of this study was to analyze the incidence, risk factors and management of CMV infection after LDLT.
  
  
  METHODS
  Retrospective analysis was performed with 72 consecutive adult cases.
  
  
  RESULTS
  CMV antigenemia was demonstrated in 31 (43.1%) patients and 9 patients (12.5%) manifested fever. Twelve patients were treated with intravenous ganciclovir (GCV) injection. There was improvement in 10 patients; foscanet concomitant with CMV-IG was administered in one patient who had an adverse effect resulting in improvement and another one resulted in death from sepsis. Twelve patients were given oral valganciclovir (VGCV) and all showed improvement. ABO incompatible transplantation was associated with CMV infection after LDLT in both the univariate (p=0.005) and multivariate analyses (p=0.04). After discharge 12 out of 63 patients (19%) suffered from CMV infection and all of them were taking steroid.
  
  
  CONCLUSIONS
  ABO incompatible transplantation was demonstrated as a risk factor for CMV infection during hospitalization. After discharge immunosuppressive status seemed to be more essential as a predictor for CMV infection. Routine examination to detect CMV antigenemia is needed especially in patients with potentially over-immunosuppressive conditions in out-patient clinics.
authors.affiliation: Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. ymanouch@gk9.so-net.ne.jp
authors.forename: Kosho
authors.initials: K
authors.lastname: Yamanouchi
authors.forename: Susumu
authors.initials: S
authors.lastname: Eguchi
authors.forename: Mitsuhisa
authors.initials: M
authors.lastname: Takatsuki
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kamohara
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hidaka
authors.forename: Kensuke
authors.initials: K
authors.lastname: Miyazaki
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Inokuma
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Tajima
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanematsu
mesh_terms: D000017:ABO Blood-Group System; D000368:Aged; D000553:Ambulatory Care; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001787:Blood Group Incompatibility / Q000150:complications; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D005260:Female; D017245:Foscarnet / Q000009:adverse effects / Q000627:therapeutic use*; D015774:Ganciclovir / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D000077562:Valganciclovir
chemical_list: D000017:ABO Blood-Group System; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D017245:Foscarnet; D000077562:Valganciclovir; D015774:Ganciclovir