The Combined Effects of Induction Regimens and Antiviral Prophylaxis on the Risk of CMV Infection in Different Serostatus Subgroups After Liver Transplantation.

C. Low,² S. Hosseini-Moghaddam,^1,2 C. Rotstein,² E. Renner,² A. Humar,² D. Kumar,² S. Husain.²

¹Medicine, Western University, London Health Sciences Centre, London, Canada
²University Health Network, Toronto, Canada

Meeting: 2017 American Transplant Congress

Abstract number: 528

Keywords: Cytomeglovirus, Infection, Liver transplantation

Session Information

Session Name: Concurrent Session: Liver: Immunosuppression and Rejection

Session Type: Concurrent Session

Date: Tuesday, May 2, 2017

Session Time: 4:30pm-6:00pm

Presentation Time: 5:30pm-5:42pm

Location: E451b

Introduction: Simultaneous effects of anti-CMV prophylaxis and induction regimens on cytomegalovirus (CMV) infection after liver transplantation (LTRs) have not been studied. We determined the magnitude of individual and combined effects of these two variables in LTRs at one year.

Methods: In a cohort design, we studied 205 D+/R+, 138 D-/R+, 57 D+/R- and 83 D-/R- consecutive LTRs. Induction regimens included steroid, rabbit antithymocyte globulin (rATG) and basiliximab. CMV prophylaxis with valganciclovir was optional after induction with rATG. CMV serostatus of the donors (D+ vs D-) and recipients (R+ vs R-) were determined at the time of transplantation. Logistic regression analysis, Cox proportional-hazards regression model and log-rank test were performed.

Results: 164 (39%), 69 (16%) and 193 (45%) patients received steroid-only, basiliximab and rATG, respectively. The frequency of CMV infection was 40% in D+/R- (23/57), 18.5% (38/205) in D+/R+, 11.6% (16/138) in D-/R+ and 2.4% (2/83)in D-/R- LTRs. Among CMV R+ LTRs who received rATG, the use of at least 6 weeks prophylaxis reduced the rate of CMV infection from 24.4% (19/78) to 11.7% (9/77). In multivariate analysis, CMV R+ versus D-/R- (OR=13.1, 95%CI: 1.8-97.2), rATG >3mg/kg versus steroid-only induction (OR=1.6, 95%CI: 1.1-2.3) and CMV prophylaxis <6 weeks versus ≥6 weeks (OR=2.7, 95%CI: 1.2-6.4) were independently associated with CMV infection. Even after complete course of 12 weeks prophylaxis in D+/R- subgroup, the risk of CMV infection remained considerably high. Survival analysis showed significant risk of CMV infection in D+/R- patients beyond 3 months prophylaxis. Conclusion: Induction with rATG increases the risk of CMV infection in seropositive LTRs. Routine antiviral prophylaxis for at least 12 weeks is recommended for R+ patients who receive induction with rATG. Further interventional studies are needed to show the effect of extended duration of prophylaxis in D+/R- patients.

CITATION INFORMATION: Low C, Hosseini-Moghaddam S, Rotstein C, Renner E, Humar A, Kumar D, Husain S. The Combined Effects of Induction Regimens and Antiviral Prophylaxis on the Risk of CMV Infection in Different Serostatus Subgroups After Liver Transplantation. Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Low C, Hosseini-Moghaddam S, Rotstein C, Renner E, Humar A, Kumar D, Husain S. The Combined Effects of Induction Regimens and Antiviral Prophylaxis on the Risk of CMV Infection in Different Serostatus Subgroups After Liver Transplantation. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/the-combined-effects-of-induction-regimens-and-antiviral-prophylaxis-on-the-risk-of-cmv-infection-in-different-serostatus-subgroups-after-liver-transplantation/. Accessed November 25, 2024.

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