title: Antiviral prophylaxis versus preemptive therapy to prevent cytomegalovirus infection and related death in liver transplantation: a retrospective study with propensity score matching.
abstract: BACKGROUND
  Cytomegalovirus (CMV), the most significant viral infection in liver transplant recipients, is addressed by 2 methods: Preemptive therapy (PT) or universal prophylaxis (UP).
  
  
  METHODS
  We analyzed medical records including at least 1 year follow-up of patients who underwent liver transplantation from 2006 to 2009 in 3 tertiary hospitals. PT was used in 2 hospitals (PT group), whereas UP with valganciclovir for 3 months was adopted in the other hospital (UP group). The 2 groups were matched using propensity scoring by perioperative variables. We performed a 1:1 comparison of the efficacy of UP and PT.
  
  
  RESULTS
  We analyzed 634 liver transplant patients, including 562 matched subjects. Baseline characteristics and underlying liver status were comparable. CMV immunoglobulin G of recipients was positive in 98.9% of the PT group and 99.3% of the UP group. CMV viremia episodes that required administration of an antiviral agent occurred in 26 (9.3%) PT and 37 (13.2%) UP subjects (P = .18). CMV-related mortalities were similar (0.7% vs 1.8%; P = .45), but all-cause mortality was higher in the PT group (18.5% vs 13.2%; P = .08).
  
  
  CONCLUSIONS
  The efficacy of PT was similar to UP to prevent CMV disease and related mortality among a group at moderate risk for CMV infection.
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
authors.forename: S I
authors.initials: SI
authors.lastname: Kim
authors.forename: C J
authors.initials: CJ
authors.lastname: Kim
authors.forename: Y J
authors.initials: YJ
authors.lastname: Kim
authors.forename: H
authors.initials: H
authors.lastname: Son
authors.forename: Y E
authors.initials: YE
authors.lastname: Kim
authors.forename: M S
authors.initials: MS
authors.lastname: Kim
authors.forename: S
authors.initials: S
authors.lastname: Hwang
authors.forename: J I
authors.initials: JI
authors.lastname: Kim
authors.forename: Y K
authors.initials: YK
authors.lastname: You
authors.forename: D G
authors.initials: DG
authors.lastname: Kim
authors.forename: M W
authors.initials: MW
authors.lastname: Kang
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage*; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir