Abstract
ObjectivesCytomegalovirus (CMV) infections in liver transplant recipients are common and result in significant morbidity and mortality. Intravenous ganciclovir or oral valganciclovir are the standard treatment for CMV infection. The present study investigates the efficacy of oral valganciclovir in CMV infection as a preemptive treatment after liver transplantation.MethodsBetween 2012 and 2013, 161 patients underwent liver transplantation at Samsung Medical Center. All patients received tacrolimus, steroids, and mycophenolate mofetil. Patients with CMV infection were administered oral valganciclovir (VGCV) 900mg/day daily or intravenous ganciclovir (GCV) 5mg/kg twice daily as preemptive treatment. Stable liver transplant recipients received VGCV.ResultsEighty-three patients (51.6%) received antiviral therapy as a preemptive treatment because of CMV infection. The model for end-stage liver disease (MELD) score and the proportions of Child-Pugh class C, hepatorenal syndrome, and deceased donor liver transplantation in the CMV infection group were higher than in the no CMV infection group. Sixty-one patients received GCV and 22 patients received VGCV. The MELD scores in the GCV group were higher than in the VGCV group, but there were no statistical differences in the pretransplant variables between the two groups. AST, ALT, and total bilirubin levels in the GCV group were higher than in the VGCV group when CMV infection occurred. The incidences of recurrent CMV infection in the GCV and VGCV groups were 14.8% and 4.5%, respectively (P=0.277).ConclusionOral valganciclovir is feasible as a preemptive treatment for CMV infection in liver transplant recipients with stable graft function.
Highlights
Cytomegalovirus (CMV) infections in liver transplant recipients are one of the most common infectious complications and result in significant morbidity and mortality
The model for end-stage liver disease (MELD) scores in the GCV group were higher than in the VGCV group, but there were no statistical differences in the pretransplant variables between the two groups
Oral valganciclovir is feasible as a preemptive treatment for CMV infection in liver transplant recipients with stable graft function
Summary
Cytomegalovirus (CMV) infections in liver transplant recipients are one of the most common infectious complications and result in significant morbidity and mortality. The incidence of CMV infection in CMV seropositive donors and seropositive recipients (CMV D+/R+) is approximately 23% to 85% after LT, and 15% to 20% of these recipients develop CMV disease [1,2,3]. CMV infection has direct and indirect effects in liver transplant recipients [4]. CMV disease as a direct effect of CMV infection is a risk factor for graft and patient survival in liver transplant recipients with CMV D+/R+ [3]. The indirect effects of CMV infection in liver transplant recipients are chronic rejection, interaction with hepatitis C virus (HCV), HCV recurrence, posttransplant lymphoproliferative disorder, and diabetes [5]. Intravenous ganciclovir or oral valganciclovir are the standard treatment for CMV infection
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