Background: Cytomegalovirus (CMV) is the most common viral pathogen that affects patient outcomes after liver transplant. Potent immunosuppressive agents predispose patients to an increased risk of CMV infection. Despite this, there is no published data assessing the risk of CMV infection associated with the use of cyclosporine (CSA) vs. tacrolimus (FK) among liver transplant recipients. We aim to compare the incidence of CMV infection among liver transplant patients receiving maintenance immunosuppression with CSA and FK at our center.

Methods: Adult patients who received a liver transplant between 2/1/2007 and 7/15/2015 and subsequently developed CMV viremia within the first year post-transplant were eligible for inclusion in this single-center, retrospective cohort study. Patients were excluded if their immunosuppression regimen did not include CSA or FK. The primary outcome was development of CMV infection, defined as the presence of detectable CMV DNA in peripheral blood by polymerase chain reaction (PCR). Secondary outcomes included treatment success, defined as sustained CMV PCR negativity; time to viral eradication of CMV infection; and mortality.

Results: Of 198 transplants performed, 110 patients received CSA and 77 patients received FK. Eighteen patients in the CSA group and 23 patients in the FK group developed CMV infection (16.4% vs. 29.9%; p = 0.03). No significant differences in rates of treatment success (58.3% vs. 61.5%; p = 1.00), mean time to viral eradication (16 vs. 21 days; p = 0.13), or mortality (22.2% vs. 8.7%; p = 0.38) were observed between the CSA and FK groups, respectively. Triple maintenance immunosuppression regimens that included the use of corticosteroids were more common among the FK group than the CSA group (43.5% vs. 27.8%; p = 0.35). Patients in the CSA group had a higher rate of concomitant bacterial infection than the FK group (33.3% vs. 0%; p < 0.01).

Conclusions: Use of FK was associated with an increased incidence of CMV infection compared with use of CSA among liver transplant recipients at our center. In light of this, larger studies evaluating the incidence of CMV infection among patients receiving CSA and FK are warranted.

CITATION INFORMATION: Burrelli C, Bradley M, Pouch S, Elkhammas E, Winters H. Incidence of Cytomegalovirus Infection Among Liver Transplant Recipients Maintained on a Cyclosporine vs. Tacrolimus-Based Immunosuppression Regimen. Am J Transplant. 2017;17 (suppl 3).

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