*Purpose: Human cytomegalovirus (CMV) is a ubiquitous beta herpesvirus present in the human population at rates between 30% and 90%. It can be transmitted via saliva, sexual contact, placental transfer, breastfeeding, blood transfusion, and solid organ transplant. Transplant recipients are at highest risk for infection in the first 3-6 months post-transplant. Agents used for viral prophylaxis in liver transplant typically include either acyclovir or valganciclovir. Which viral prophylaxis agent to use and subsequent duration of treatment has not been well-defined in the CMV guidelines for liver transplant.

*Methods: This was a single-center retrospective cohort study. Data was collected via chart review of electronic medical records. The primary endpoint was the CMV infection rate within the first 6 months of transplant. Secondary endpoints included in-hospital positive CMV PCR, diagnosis of CMV viremia or disease while on prophylaxis, and diagnosis of CMV viremia or disease within 3 months of discontinuing viral prophylaxis. Recipients of simultaneous liver kidney or liver heart transplants were excluded from this study. Patients were stratified into high (D+/R-), intermediate (D+/R+) (D-/R+) and low (D-/R-) risk groups based on their likelihood of developing CMV after transplant. Patients in the low and intermediate risk groups received viral prophylaxis with acyclovir for 3 months, whereas those in the high-risk group received valganciclovir for 3 months.

*Results: 86 patients were included in the analysis. Of those 86 patients, 10 were low-risk, 56 were intermediate-risk, and 20 were high risk for CMV. No patients in the low-risk group developed CMV during the study period compared to 30.4% in the intermediate-risk group and 25% in the high-risk group (p=0.12). Compared to the high-risk group, more patients in the intermediate-risk developed CMV during the prophylaxis period (p=0.016). In addition, more patients in the high-risk group developed CMV after the prophylaxis period compared to the intermediate-risk group (p=0.016).

*Conclusions: Overall, there was no significant difference in CMV rates between intermediate and high-risk groups. However, patients in the intermediate-risk group treated with acyclovir developed CMV during the prophylaxis period at a significantly higher rate than those in the high-risk group treated with valganciclovir. Patients in the high-risk group developed CMV after prophylaxis at a significantly higher rate than those in the intermediate-risk group. This data suggests that intermediate-risk liver transplant recipients require valganciclovir for prophylaxis of CMV. Similar to the data in high-risk renal transplant, this data suggests 3 months of valganciclovir may be an insufficient length of treatment for high-risk liver transplant patients.

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