Premium
Prophylaxis versus pre‐emptive treatment for prevention of cytomegalovirus infection in CMV‐seropositive orthotopic liver‐transplant recipients
Author(s) -
Mengelle Catherine,
Rostaing Lionel,
Weclawiak Hugo,
Rossignol Cécile,
Kamar Nassim,
Izopet Jacques
Publication year - 2015
Publication title -
journal of medical virology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.782
H-Index - 121
eISSN - 1096-9071
pISSN - 0146-6615
DOI - 10.1002/jmv.23964
Subject(s) - cytomegalovirus , virology , medicine , betaherpesvirinae , cytomegalovirus infection , cytomegalovirus infections , viral disease , herpesviridae , immunology , human cytomegalovirus , virus
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. J. Med. Virol. 87:836–844, 2015 . © 2015 Wiley Periodicals, Inc.