Impact of cytomegalovirus in organ transplant recipients in the era of antiviral prophylaxis

被引:194
作者
Limaye, Ajit P.
Bakthavatsalam, Ramasamy
Kim, Hyung W.
Randolph, Sara E.
Halldorson, Jeffrey B.
Healey, Patrick J.
Kuhr, Christian S.
Levy, Adam E.
Perkins, James D.
Reyes, Jorge D.
Boeckh, Michael
机构
[1] Univ Washington, Ctr Med, Dept Lab Med, Seattle, WA 98195 USA
[2] Univ Washington, Dept Med, Seattle, WA 98195 USA
[3] Univ Washington, Dept Surg, Seattle, WA 98195 USA
[4] Fred Hutchinson Canc Res Ctr, Program Infect Dis, Seattle, WA 98104 USA
[5] Univ Washington, Dept Pharm, Seattle, WA 98195 USA
关键词
cytomegalovirus; liver transplant; complications; mortality; risk factors;
D O I
10.1097/01.tp.0000226071.12562.1a
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Antiviral prophylaxis has been shown to decrease the incidence of cytomegalovirus (CMV) disease in organ transplant recipients, but whether CMV disease that occurs despite prophylaxis is associated with mortality remains unknown. Methods. The clinical features and risk factors for CMV disease in a cohort of liver transplant recipients who received antiviral prophylaxis were assessed retrospectively. Cox proportional hazard regression was used to assess the relationship of CMV to mortality during the first posttransplant year. Results. CMV disease developed in 37 of 437 (8.5%) recipients at a median of 4.5 (range, 2.5 to 12) months posttransplant and was associated only with donor-seropositive/recipient-seronegative serostatus in multivariate analysis (P < 0.0001). Mortality at 1 year was 12% (51 of 437) and was infection-associated in 49% of cases. In multivariate analysis, CMV disease was independently associated with overall mortality at 1 year (HR, 5. 1, P=0.002) and even more strongly with infection-associated mortality (HR 11, P=0.002). There was no association of CMV with noninfection-associated mortality (P > 0.05). Conclusions. Late CMV disease is an important clinical problem in liver transplant recipients who receive antiviral prophylaxis, and is strongly and independently associated with mortality. Strategies to prevent late CMV disease are warranted.
引用
收藏
页码:1645 / 1652
页数:8
相关论文
共 50 条
[41]   Valganciclovir is an effective prophylaxis for cytomegalovirus disease in liver transplant recipients [J].
Fayek, Sameh Adel ;
Mantipisitkul, Wana ;
Rasetto, Flavia ;
Munivenkatappa, Raghava ;
Barth, Rolf N. ;
Philosophe, Benjamin .
HPB, 2010, 12 (10) :657-663
[42]   Cytomegalovirus myocarditis in solid organ transplant recipients: A case series and review of literature [J].
Scherger, Sias ;
Mathur, Swati ;
Bajrovic, Valida ;
Johnson, Steven C. ;
Benamu, Esther ;
Ramanan, Poornima ;
Wolfel, Gene ;
Levi, Marilyn E. ;
Abidi, Maheen Z. .
TRANSPLANT INFECTIOUS DISEASE, 2020, 22 (03)
[43]   Valganciclovir Dosing for Cytomegalovirus Prophylaxis in Solid-organ Transplant Recipients on Continuous Veno-venous Hemodialysis [J].
Jarrell, Andrew S. ;
Crow, Jessica R. ;
Strout, Sara E. ;
Kruer, Rachel M. ;
Toman, Lindsey P. ;
Dioverti-Prono, Maria, V ;
Lees, Laura ;
Avery, Robin K. ;
Marzinke, Mark A. .
CLINICAL INFECTIOUS DISEASES, 2021, 73 (01) :101-106
[44]   Prevention and Treatment of Cytomegalovirus Infections in Solid Organ Transplant Recipients [J].
Koval, Christine E. .
INFECTIOUS DISEASE CLINICS OF NORTH AMERICA, 2018, 32 (03) :581-+
[45]   Prevention and treatment of cytomegalovirus infection in solid organ transplant recipients [J].
Pereyra, F ;
Rubin, RH .
CURRENT OPINION IN INFECTIOUS DISEASES, 2004, 17 (04) :357-361
[46]   Antimicrobial Resistance in Organ Transplant Recipients [J].
Giannella, Maddalena ;
Rinaldi, Matteo ;
Viale, Pierluigi .
INFECTIOUS DISEASE CLINICS OF NORTH AMERICA, 2023, 37 (03) :515-537
[47]   Cytomegalovirus Disease as a Risk Factor for Invasive Fungal Infections in Liver Transplant Recipients under Targeted Antiviral and Antimycotic Prophylaxis [J].
Breitkopf, Robert ;
Treml, Benedikt ;
Bukumiric, Zoran ;
Innerhofer, Nicole ;
Fodor, Margot ;
Spurnic, Aleksandra Radovanovic ;
Rajsic, Sasa .
JOURNAL OF CLINICAL MEDICINE, 2023, 12 (16)
[48]   Cytomegalovirus in liver transplant recipients [J].
Herman, David ;
Han, Hyosun .
CURRENT OPINION IN ORGAN TRANSPLANTATION, 2017, 22 (04) :345-350
[49]   Human cytomegalovirus: a survey of end-organ diseases and diagnostic challenges in solid organ transplant recipients [J].
Contreras, Gustavo ;
Ho, Dora .
CURRENT OPINION IN ORGAN TRANSPLANTATION, 2022, 27 (04) :243-249
[50]   Cytomegalovirus surveillance after antiviral prophylaxis in CMV mismatched transplant patients: Does recurrent cytomegalovirus DNAemia impact patient survival? [J].
Fernandez-Garcia, Oscar A. ;
Hernandez, Cristina ;
Robbins, Mark ;
Kabbani, Dima ;
Doucette, Karen ;
Cervera, Carlos .
TRANSPLANT INFECTIOUS DISEASE, 2024, 26 (04)