title: Prophylaxis versus pre-emptive treatment for prevention of cytomegalovirus infection in CMV-seropositive orthotopic liver-transplant recipients.
abstract: This study compared the pre-emptive and the prophylactic strategies used to prevent cytomegalovirus (CMV) infection and disease in CMV-seropositive orthotopic liver-transplant recipients and searched for associated predictive factors. Seventy-three orthotopic liver-transplant recipients who had received a transplant before November 2005 were given ganciclovir IV pre-emptively (group I) and 56 recipients who had received a transplant after November 2005 were given prophylactic valganciclovir for 3 months (group II). Demographic and biochemical parameters did not statistically vary between the groups at baseline. Monitoring of CMV DNAemia was similar in both groups. Forty-two (57.5%) patients presented with CMV infection in group I and 18 (32.1%) in group II (P < 0.004). CMV DNAemia was first detected at a median of 33 days post-transplant in group I and at 98.5 days in group II (P < 0.003), but viral loads were not significantly different. The overall incidence of CMV disease was 9.6% in group I versus 7.1% in group II (ns). Thirty-five (47.9%) patients presented with biopsy-proven acute rejection in group I and 13 (23.2%) in group II (P = 0.004). Forty (55%) patients in group I and 25 (44.6%) in group II presented with de novo post-transplant diabetes (P = 0.057). At 1-year post-transplant, global survival curves were not significantly different. Independent factors associated with CMV reactivation were an absence of CMV prophylaxis, CMV serological status of the donor, cold ischemia time, and HLA A + B + DR compatibility. CMV prophylaxis is efficacious and can prevent safely the direct and indirect effects of CMV infection in CMV-seropositive orthotopic liver-transplant recipients.
authors: Department of Virology, CHU Purpan, Toulouse, France.
authors: Catherine
authors: C
authors: Mengelle
authors: Lionel
authors: L
authors: Rostaing
authors: Hugo
authors: H
authors: Weclawiak
authors: Cécile
authors: C
authors: Rossignol
authors: Nassim
authors: N
authors: Kamar
authors: Jacques
authors: J
authors: Izopet
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage*; D018890:Chemoprevention / Q000379:methods*; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000517:prevention & control*; D004279:DNA, Viral / Q000032:analysis / Q000097:blood; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D013997:Time Factors; D066027:Transplant Recipients; D000077562:Valganciclovir; D019562:Viral Load; D014766:Viremia / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D007166:Immunosuppressive Agents; D000077562:Valganciclovir; D015774:Ganciclovir
keywords: CMV-DNAemia; CMV-infection prevention strategies; ganciclovir; valganciclovir