Deferred versus prophylactic therapy with gancyclovir for cytomegalovirus in allograft liver transplantation

Abstract

Objective The aim of this study was to assess the efficacy of deferred versus prophylactic therapy with gancyclovir to prevent cytomegalovirus (CMV) infection or disease in liver transplantation recipients, and to alter the timing of infection or the incidences of acute rejection, chronic rejection, or death. Methods We retrospectively studied 89 consecutive liver transplant recipients with a minimum of 1 year follow-up. CMV early antigen detection (pp65) was performed weekly for the first 2 months and thereafter monthly for an additional 10 months. Forty-one recipients were administered prophylactic treatment and (48 recipients) deferred therapy for positive antigenemia. Results During the first year after transplantation, CMV infection or disease developed in 61% or 12.2% of those treated with prophylactic therapy and 54.1% or 31.3% of those treated with deferred therapy ( P = 0.51 or P = 0.032, respectively). The mean time to CMV disease in the prophylactic group was 161+/−33 days compared with 82+/−27 days for the deferred therapy arm ( P < 0.001). Subgroup analysis based on CMV serological status also showed prophylactic treatment significantly diminished CMV disease in the CMV IgG antibody negative group. No patients died in the prophylactic group, and one died in the deferred group ( P = 0.54). The incidence of acute rejection episodes was 34% in the prophylactic and 46% in the deferred group ( P = 0.26). Chronic rejection was observed in two recipients in the prophylactic group versus one recipient in the deferred arm ( P = 0.35). Conclusion Compared with deferred therapy prophylactic therapy with gancyclovir decreased CMV disease and delayed the onset of CMV disease after liver transplantation.