Early and Delayed Onset Cytomegalovirus Infection of Liver Transplant Recipients in Endemic Areas

Background. The delayed onset of cytomegalovirus (CMV) infection after liver transplantation can place patients at risk for graft failure and mortality. Methods. We compared early versus delayed onset of CMV infection to identify risk factors for mortality among liver transplant recipients in an endemic area. Results. Among 710 consecutive adult liver transplant recipients, incidence of CMV infection was 47.5% (337/710). Male gender, biliary complications, acute rejection episodes, antilymphocyte antibodies high hemoglobin, and high total bilirubin were significantly different among patients with delayed versus early onset CMV infections. The overall incidence of early versus delayed CMV infections was 43.1% (306/710) versus 4.4% (31/710). Among them, 11.1% (34/306) and 25.8% (8/31) of patients developed CMV disease. Conclusion. These results showed that a higher proportion of patients developed disease among delayed CMV infected patients (P = .039). The overall and graft survival curves for patients with early onset CMV infections were better than those of patients who had delayed onset CMV infections (P = .026 and P = .014). Recurrence of hepatitis B virus, hepatic dysfunction, and retransplantation were associated with increased mortality among patients who had a delayed CMV infection.