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Incidence, risk factors, and outcomes associated with cytomegalovirus disease in small bowel transplant recipients
Author(s) -
Florescu D. F.,
Langnas A. N.,
Grant W.,
Mercer D. F.,
Botha J.,
Qiu F.,
Shafer L.,
Kalil A. C.
Publication year - 2012
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/j.1399-3046.2011.01628.x
Subject(s) - medicine , serostatus , immunosuppression , incidence (geometry) , transplantation , cytomegalovirus , disease , gastroenterology , ganciclovir , immunology , herpesviridae , viral disease , viral load , human cytomegalovirus , virus , physics , optics
Florescu DF, Langnas AN, Grant W, Mercer DF, Botha J, Qiu F, Shafer L, Kalil AC. Incidence, risk factors, and outcomes associated with cytomegalovirus disease in small bowel transplant recipients. Abstract: Despite improved prophylaxis, monitoring, and more efficient immunosuppression, CMV infection remains a common opportunistic infection in transplant recipients. We assessed the incidence of CMV disease in pediatric SBT recipients, the timing of CMV disease after transplantation, and its impact on patient outcome. The medical records of 98 SBT recipients were reviewed. We performed descriptive analysis, regression analysis, and Kaplan–Meier curves to determine the time‐to‐event after transplantation. Fifty‐three percent patients were male and 47% female, with a mean age of 38.3 months. Thirty‐five percent of patients received prophylactic VGC, 55% GCV, 10% a combination of GCV/VGC, and 99% CMV immunoglobulins. A total of 24.5% recipients were CMV D+/R− (CMV serostatus donor positive/recipient negative). Seven ( c. 7%) patients developed CMV disease. CMV disease was associated with 2.5 times (0.52–12.1; p = 0.25) higher rate of CMV mismatch and 11.1 times (1.3–95.9; p = 0.03) higher risk of death. CMV prophylaxis increased time‐to‐death (p = 0.074). Time‐to‐CMV disease was shorter in patients with enteritis (p < 0.0001), and CMV disease was associated with shorter time‐to‐death after transplantation (p = 0.001). CMV disease in SBT recipients was associated with an 11‐fold mortality increase and a fourfold faster time‐to‐death. Time‐to‐death was significantly shorter with CMV enteritis.