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Impact of cytomegalovirus prophylaxis on rejection following orthotopic liver transplantation
Author(s) -
Slifkin Michelle,
Ruthazer Robin,
Freeman Richard,
Bloom Judy,
Fitzmaurice Susan,
Fairchild Ralph,
Angelis Michael,
Cooper Jeffrey,
Barefoot Laurie,
Rohrer Richard,
Snydman David R.
Publication year - 2005
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.20523
Subject(s) - medicine , immunosuppression , serostatus , liver transplantation , ganciclovir , cytomegalovirus , gastroenterology , transplantation , bacteremia , tacrolimus , chemoprophylaxis , surgery , human cytomegalovirus , immunology , herpesviridae , viral disease , antibiotics , viral load , virus , microbiology and biotechnology , biology
With improved cytomegalovirus (CMV) prophylaxis, CMV disease after liver transplantation has decreased dramatically, and patient and graft survival have improved. We examined the impact of CMV prophylaxis on biopsy proven rejection after orthotopic liver transplantation by analyzing data on 192 liver recipients over 5 years (1994‐1999). Risk factors assessed for biopsy proven rejection including donor and recipient age, CMV serostatus; CMV prophylaxis; immunosuppression; bacteremia and blood product use were examined over a 2‐year follow‐up. Multivariate analysis of risk factors for rejection showed that bacteremia (HR 3.57, 95% CI 1.39‐9.36, P =0.008), donor age (HR 1.20, 95% CI 1.06‐1.36, per 10 year increase, P =0.004), and use of cyclosporine as initial immunosuppression compared to tacrolimus (HR 1.98, 95% CI 1.27‐3.09, P=0.003) were associated with increased risk; ganciclovir prophylaxis for 3 months (HR 0.51, 95% CI 0.33 to 0.79, P =0.003) and recipient age (HR 0.78; 95% CI 0.63‐0.96, for each 10 year increase, P =0.03) were associated with decreased risk. We conclude that, the use of CMV prophylaxis with ganciclovir significantly reduces the incidence of biopsy proven rejection in liver transplant recipients. (Liver Transpl 2005;11:1597–1602.)