title: Cytomegalovirus Infection After Intestinal/Multivisceral Transplantation: A Single-Center Experience With 210 Cases.
abstract: BACKGROUND
  Cytomegalovirus (CMV) infection is the most prevalent infectious complication after solid organ transplantation, and recipients of isolated intestinal transplantation (IIT)/multivisceral transplantation (MVT) are among those at the highest risk. Limited clinical data exist regarding CMV infection after IIT/MVT. The aim of this study is to analyze risk factors for posttransplant CMV infection and to assess the efficacy and validity of our prophylaxis and treatment regimens in intestinal transplantation.
  
  
  METHODS
  Medical records of 210 IIT/MVT patients were retrospectively reviewed. Posttransplant CMV prophylaxis regimen consisted of ganciclovir followed by 1 year of valganciclovir. The addition of CMV immunoglobulin (CMVIG) was decided according to donor/recipient CMV serostatus (D/R). All results of CMV PCR and/or pp65 antigenemia, and pathological reports were reviewed. Time to the incidence of CMV infection (viremia and/or tissue invasive disease) and risk factors for CMV infection were investigated.
  
  
  RESULTS
  CMV infection was observed in 34 of 210 (16%) with a median onset of 347 days. Rejection was significantly associated with CMV infection (P = 0.01, odds ratio = 2.61). In the high-risk serostatus group (D+/R-), prophylactic CMVIG and induction with high-dose rabbit antithymocyte globulin (>10 mg/kg) were associated with a lower CMV infection rate on univariate analysis. The CMVIG remained to be an independent factor on multivariate analysis (P = 0.04, hazard ratio = 0.93/dose). Mortality associated with CMV infection occurred in 4, and CMV infection adversely affected patient survival (P = 0.001, hazard ratio = 2.71).
  
  
  CONCLUSIONS
  Prophylaxis with CMVIG and appropriate induction with rabbit antithymocyte globulin may be important to reduce CMV infection in high-risk serostatus group (D+/R-).
authors.affiliation: 1 Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Shunji
authors.initials: S
authors.lastname: Nagai
authors.forename: Richard S
authors.initials: RS
authors.lastname: Mangus
authors.forename: Eve
authors.initials: E
authors.lastname: Anderson
authors.forename: Burcin
authors.initials: B
authors.lastname: Ekser
authors.forename: Chandrashekhar A
authors.initials: CA
authors.lastname: Kubal
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Fridell
authors.forename: A Joseph
authors.initials: AJ
authors.lastname: Tector
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control* / Q000821:virology; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage*; D016756:Immunoglobulins, Intravenous; D015994:Incidence; D007196:Indiana / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D007422:Intestines / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016377:Organ Transplantation / Q000009:adverse effects*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D000077562:Valganciclovir; D014781:Viscera / Q000637:transplantation*; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous; C045781:cytomegalovirus-specific hyperimmune globulin; D000077562:Valganciclovir; D015774:Ganciclovir