title: Two strategies for prevention of cytomegalovirus infections after liver transplantation.
abstract: OBJECTIVE
  To analyze differences in patients' clinical course, we compared two regimes of either preemptive therapy or prophylaxis after liver transplantation.
  
  
  METHODS
  This retrospective study was reviewed and approved by the institutional review board of the University of Leipzig. Cytomegalovirus (CMV) prophylaxis with valganciclovir hydrochloride for liver transplant recipients was replaced by a preemptive strategy in October 2009. We retrospectively compared liver transplant recipients 2 years before and after October 2009. During the first period, all patients received valganciclovir daily. During the second period all patients included in the analysis were treated following a preemptive strategy. Outcomes included one year survival and therapeutic intervention due to CMV viremia or infection.
  
  
  RESULTS
  Between 2007 and 2010 n = 226 patients underwent liver transplantation in our center. n = 55 patients were D(+)/R(-) high risk recipients and were excluded from further analysis. A further 43 patients had to be excluded since CMV prophylaxis/preemptive strategy was not followed although there was no clinical reason for the deviation. Of the remaining 128 patients whose data were analyzed, 60 received prophylaxis and 68 were treated following a preemptive strategy. The difference in overall mortality was not significant, nor was it significant for one-year mortality where it was 10% (95%CI: 8%-28%, P = 0.31) higher for the preemptive group. No significant differences in blood count abnormalities or the incidence of sepsis and infections were observed other than CMV. In total, 19 patients (14.7%) received ganciclovir due to CMV viremia and/or infections. Patients who were treated according to the preemptive algorithm had a significantly higher rate risk of therapeutic intervention with ganciclovir [n = 16 (23.5%) vs n = 3 (4.9%), P = 0.003)].
  
  
  CONCLUSIONS
  These data suggest that CMV prophylaxis is superior to a preemptive strategy in patients undergoing liver transplantation.
authors.affiliation: Philipp Simon, Max Sasse, Sven Laudi, Udo X Kaisers, Sven Bercker, Department of Anesthesia and Intensive Care Medicine, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Simon
authors.affiliation: Philipp Simon, Max Sasse, Sven Laudi, Udo X Kaisers, Sven Bercker, Department of Anesthesia and Intensive Care Medicine, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany.
authors.forename: Max
authors.initials: M
authors.lastname: Sasse
authors.affiliation: Philipp Simon, Max Sasse, Sven Laudi, Udo X Kaisers, Sven Bercker, Department of Anesthesia and Intensive Care Medicine, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Laudi
authors.affiliation: Philipp Simon, Max Sasse, Sven Laudi, Udo X Kaisers, Sven Bercker, Department of Anesthesia and Intensive Care Medicine, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Petroff
authors.affiliation: Philipp Simon, Max Sasse, Sven Laudi, Udo X Kaisers, Sven Bercker, Department of Anesthesia and Intensive Care Medicine, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Bartels
authors.affiliation: Philipp Simon, Max Sasse, Sven Laudi, Udo X Kaisers, Sven Bercker, Department of Anesthesia and Intensive Care Medicine, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany.
authors.forename: Udo X
authors.initials: UX
authors.lastname: Kaisers
authors.affiliation: Philipp Simon, Max Sasse, Sven Laudi, Udo X Kaisers, Sven Bercker, Department of Anesthesia and Intensive Care Medicine, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Bercker
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003587:Cytomegalovirus / Q000187:drug effects* / Q000472:pathogenicity; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control* / Q000821:virology; D004334:Drug Administration Schedule; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D005858:Germany; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir
keywords: Cytomegalovirus; Liver; Preemptive; Prophylaxis; Therapy; Transplantation; Valganciclovir