The effect of different immunoprophylaxis regimens on post‐transplant cytomegalovirus (CMV) infection in CMV‐seropositive liver transplant recipients

Background The effects of different immunoprophylaxis regimens on cytomegalovirus ( CMV ) infection in liver transplant recipients ( LTR s) have not been compared. Methods In a cohort, we studied 343 CMV ‐seropositive recipient (R+) and 83 seronegative donor/recipient (D−/R−) consecutive LTR s from 2004 to 2007. Immunoprophylaxis regimens included steroid‐only, steroids plus rabbit anti‐thymocyte globulin ( rATG ), and steroids plus basiliximab. Logistic regression analysis, Cox proportional hazards regression model, and log‐rank test were performed for multivariate analysis as appropriate. Results In total, 164 (39%), 69 (16%), and 193 (45%) patients received steroid‐only, basiliximab, and rATG immunoprophylaxis, respectively. CMV infection rates were 15.7% (54/343) in CMV R+ LTR s and 2.4% (2/83) in CMV R− LTR s. Among CMV R+ LTR s who received rATG , the use of at least 6 weeks of CMV prophylaxis reduced the rate of CMV infection from 24.4% (19/78) to 11.7% (9/77). In multivariate analysis, CMV R+ vs D−/R− (odds ratio [ OR ]=13.1, 95% confidence interval [CI]: 1.8‐97.2), rATG >3 mg/kg vs steroid‐only induction ( OR =1.6, 95% CI : 1.1‐2.3), and CMV prophylaxis <6 weeks vs ≥6 weeks ( OR =2.7, 95% CI : 1.2‐6.4) were independently associated with CMV infection. Subgroup analysis in CMV D−/R+ group who received rATG showed that ≥6 weeks of CMV prophylaxis significantly decreased the risk of CMV infection ( OR =1.9, 95% CI : 1.1‐3.9; P =.03). Conclusion The use of rATG immunoprophylaxis increases the risk of CMV infection in CMV ‐seropositive LTR s, specifically in the CMV D−/R+ group. Prophylaxis with valganciclovir in this group for at least 6 weeks decreases the risk of CMV infection.