title: Prophylaxis versus preemptive therapy for cytomegalovirus disease in high-risk liver transplant recipients.
abstract: Cytomegalovirus (CMV) infection is an opportunistic infection frequently found after solid organ transplantation, and it contributes significantly to mortality and morbidity. CMV-seronegative recipients of grafts from CMV-seropositive donors have the highest risk of CMV disease. The most appropriate strategy for preventing CMV disease in this population is a matter of active debate. In this study, we compared prophylaxis and preemptive therapy for the prevention of CMV disease in donor-seropositive/recipient-seronegative (D+ /R-) liver recipients. To this end, we selected a retrospective cohort of liver recipients (1992-2009) for analysis. D+ /R- patients were identified from the liver transplant program database. Eighty of 878 consecutive liver recipients (9%) were D+ /R-. Six of these patients died within 30 days of transplantation and were excluded. Thirty-five of the remaining D+ /R- patients (47%) received prophylaxis, and 39 patients (53%) followed a preemptive strategy based on CMV antigenemia surveillance. Fifty-four (73%) were men, the median age was 49 years (range = 15-68 years), and the mean follow-up was 68 months (range = 8-214 months). The baseline characteristics and the initial immunosuppressive regimens were similar for the 2 groups. Ganciclovir or valganciclovir was the antiviral drug used initially in both strategy groups. CMV disease occurred more frequently among D+ /R- liver recipients receiving preemptive therapy (33.3% versus 8.6% for the prophylaxis group, P = 0.01), whereas late-onset CMV disease was found only in patients receiving prophylaxis (5.7% versus 0% for the preemptive therapy group, P = 0.22). No significant differences in acute allograft rejection, other opportunistic infections, or case fatality rates were observed. According to our data, prophylaxis was more effective than preemptive therapy in preventing CMV disease in high-risk liver transplant recipients.
authors.affiliation: Department of Infectious Diseases, University Hospital of Bellvitge, Bellvitge Biomedical Research Insitute, University of Barcelona, L'Hospitalet de Llobregat, Spain. martabodro@gmail.com
authors.forename: Marta
authors.initials: M
authors.lastname: Bodro
authors.forename: Núria
authors.initials: N
authors.lastname: Sabé
authors.forename: Laura
authors.initials: L
authors.lastname: Lladó
authors.forename: Carme
authors.initials: C
authors.lastname: Baliellas
authors.forename: Jordi
authors.initials: J
authors.lastname: Niubó
authors.forename: Jose
authors.initials: J
authors.lastname: Castellote
authors.forename: Joan
authors.initials: J
authors.lastname: Fabregat
authors.forename: Antoni
authors.initials: A
authors.lastname: Rafecas
authors.forename: Jordi
authors.initials: J
authors.lastname: Carratalà
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D000077562:Valganciclovir; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir