Cytomegalovirus Infection after Liver Transplantation– Incidence, risks and benefit of prophylaxis

Abstract

Introduction: Cytomegalovirus (CMV) infection and related disease is a feared complication after liver transplantation. Depending on CMV status of donor and recipient and individual risk profile antiviral prophylaxis is recommended in clinical practice guidelines. Patients and Methods: 211 liver transplant recipients were retrospectively analyzed with respect to incidence of CMV infection after transplantation, influence of donor and recipient CMV status and effect of antiviral prophylaxis. In addition, underlying liver disease and immunosuppressive protocol was correlated to incidence of CMV infection. Patients undergoing liver transplantation from 1/2004 to 12/2006 were included in this study. The mean follow-up time after transplantation was 24.5±13.5 month. Patients were divided in four groups according to CMV donor/recipient (D/R) profile: Group A (D-/R-), Group B (D-/R+), Group C (D+/R+), Group D (D+/R-). Results: The donor/recipient profile distributed as follows: Group A, 28 patients (pts), (13.3%), Group B, 64 pts (30.3%), Group C, 79 pts (37.4%) and Group D, 40 pts (19.0%). CMV infection was observed in 17.9%, 29.7%, 24.1% and 22.5%, respectively and was not significantly different in groups A, B, C and D. In group A with a presumed low risk profile a CMV infection occurred in 5 pts (17.9%), despite an antiviral prophylaxis in 4 out of these 5 pts. In contrast, in group D with a presumed high risk profile only in 9 of 40 pts (22.5%) CMV infection was observed in spite of prophylaxis in most patients. Most frequent infection rates were found in group B and C (R+ groups), with 29.7 and 24.1%, respectively. After successful treatment of CMV infection, no recurrence was detected. Underlying liver disease or immunosuppressive protocol had no influence on CMV infection.