Open AccessChanging impact of cytomegalovirus in liver transplantation – a single centre experience of more than 1000 transplantations without ganciclovir prophylaxis
Author(s) -
Seehofer Daniel,
Rayes Nada,
Neumann Ulf P.,
Meisel Helga,
Oettle Helmut,
Nüssler Natascha C.,
Jonas Sven,
Langrehr Jan M.,
Neuhaus Peter
Publication year - 2005
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/j.1432-2277.2005.00162.x
Subject(s) - medicine , immunosuppression , ganciclovir , liver transplantation , transplantation , cytomegalovirus , incidence (geometry) , gastroenterology , liver disease , univariate analysis , surgery , betaherpesvirinae , immunology , human cytomegalovirus , herpesviridae , viral disease , multivariate analysis , virus , physics , optics
Summary As cytomegalovirus (CMV) disease was a leading cause of death following liver transplantation in earlier reports, general CMV prophylaxis is widely used. We re‐evaluated the impact of CMV in a recent time period under balanced immunosuppression and effective CMV diagnostics and therapy. A retrospective analysis of 1200 liver transplantations between 1988 and 2000 was performed comparing the incidence of CMV infection and disease and patient survival rates in two different time periods (before and after availability of the pp65‐antigenaemia assay). In addition, risk factors for CMV in the recent time period were analysed. No ganciclovir prophylaxis was administered during the whole study period. The incidence of CMV tissue invasive disease decreased from 9.4% in period I to 2.7% in period II, whereas the incidence of viral syndrome was about 6% in both periods. Especially CMV pneumonia and generalized disease were almost abandoned in period II. Patients with tissue invasive disease, but not with infection or viral syndrome had reduced survival rates in both periods. However, the disease‐specific mortality was 10% and 0% respectively. The overall rate of CMV infection in period II was low (25.9%). Risk factors for CMV infection in the univariate analysis were: Initial nonfunction, D+R− seroconstellation, acute liver failure, triple or quadruple immunosuppression, OKT3 or ATG treatment, transfusion of >10 packed red cells, steroid boluses, postoperative mechanical ventilation and retransplantation. In the multivariate analysis only quadruple or triple immunosuppression, OKT3‐treatment, transplantation for acute liver failure and initial nonfunction. The incidence of CMV tissue invasive disease as well as the disease‐specific mortality has markedly decreased during the last years. Using routine surveillance with the pp65‐antigenaemia assay, CMV infection and disease rates compare well to data with long‐term ganciclovir prophylaxis. As D+R− patients still more often develop symptomatic disease, pre‐emptive therapy could be useful in this patient group.