Impact of CMV Viremia After Liver Transplantation: 15 Year Results of a Prospective, Randomized Clinical Trial.

Abstract

It is still under debate if cytomegalovirus (CMV) viremia after orthotopic liver transplantation (OLT) impairs patient- and graft- outcomes. Since CMV DNA is detectable before onset of symptoms, it remains unclear whether a) oral prophylaxis for all OLT-patients, b) preemptive therapy (in case of asymptomatic viremia) or c) a symptom-triggered treatment is favorable. We report on the 15-year follow up of 60 patients who developed asymptomatic CMV viremia during the first three months after OLT. These patients were enrolled in a prospective, randomized trial and I) either treated preemptively (n=30) (oral ganciclovir 3 x 1g / day for 14 days) or II) only observed (n=30). In case of symptomatic CMV disease, all patients were treated with intravenous ganciclovir (2 x 5 mg/kg body weight for 14 days). 286 OLT patients of the same time period (November 1996 - March 2000) without CMV infection served as controls. 15-year patient and graft survival did not significantly differ in the groups: (patient survival: p=0.937; graft survival: p=0.813): Preemptive therapy (63,3%; 56,7%), symptom-triggered treatment (61,9%; 55,4%), control (61,3%; 58,5%).Figure: No Caption available.Conclusion: CMV infection post-OLT can be treated effectively. The impact of antiviral prophylaxis and preemptive treatment after OLT remains unclear.