title: Risk factors and clinical outcomes of cytomegalovirus disease occurring more than one year post solid organ transplantation.
abstract: BACKGROUND
  Cytomegalovirus (CMV) disease typically occurs during the first year after solid organ transplantation, after cessation of antiviral prophylaxis. CMV occurring after the first year is uncommon and not well described.
  
  
  METHODS
  We conducted a case-control study to identify potential risk factors and a retrospective cohort study to evaluate 1-month mortality in solid organ transplant (SOT) recipients who developed CMV disease after the first year post transplant, or "very late CMV" (VLCMV), compared with those developing CMV within the first year (CMV Y1), adjusting for demographics, donor and recipient CMV serostatus, immunosuppression, rejection, and co-morbidities.
  
  
  RESULTS
  We identified 85 SOT recipients with CMV disease at a single transplant center between January 2006 and October 2008: 23 (27%) had VLCMV and 62 (73%) had CMV Y1. Heart transplantation was independently associated with increased risk (adjusted odd ratio [OR] 4.11; 95% confidence interval [CI] 1.34-12.61; P = 0.01) for VLCMV. Patients with VLCMV had increased 1-month mortality (unadjusted OR 5.39; 95% CI 1.06-27.48; P = 0.02). Mortality was uncommonly attributable to CMV.
  
  
  CONCLUSIONS
  CMV disease continues to occur after the first year post solid organ transplantation, particularly in heart transplant recipients, and can be associated with poor outcomes. CMV should be suspected in patients with symptoms or laboratory findings consistent with CMV, even if the patients present >1 year post transplant.
authors.affiliation: San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA.
authors.forename: D
authors.initials: D
authors.lastname: Blyth
authors.forename: I
authors.initials: I
authors.lastname: Lee
authors.forename: K D
authors.initials: KD
authors.lastname: Sims
authors.forename: L B
authors.initials: LB
authors.lastname: Gasink
authors.forename: T D
authors.initials: TD
authors.lastname: Barton
authors.forename: V M
authors.initials: VM
authors.lastname: Van Deerlin
authors.forename: P
authors.initials: P
authors.lastname: Pfeiffenberger
authors.forename: E A
authors.initials: EA
authors.lastname: Blumberg
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000401:mortality / Q000473:pathology / Q000821:virology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects* / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors; D014766:Viremia
chemical_list: D000998:Antiviral Agents