*Purpose: Evaluate factors related to incidence and outcomes of cytomegalovirus (CMV) infection after isolated intestinal transplantation (IT) and multivisceral transplantation (MVT).

*Methods: Retrospective evaluation of 32 IT and MVT recipients at two transplant centers between 2009 and 2019. Evaluation included demographics, immunosuppression (IS) characteristics, CMV therapy and outcomes.

*Results: A total of 32 IT and MVT patients were evaluated. All patients were over 18 years of age with mean age of 47 (Range 22-64). 41% had MVT; 59% had IT. Induction at the time of transplant included anti-thymocyte globulin (ATG) (91%), basiliximab(6.3%), rituximab(43.8%). Average length of CMV prophylaxis after transplant was 7.7 months. Dose reduction of prophylaxis was required in 53.1% of all patients due to renal disease (82.3%) or cytopenias (17.7%). There was no difference in the rate of CMV infection in those with and without reduction in prophylaxis. The average frequency of CMV monitoring in the first 3 months post-transplant was every 3 weeks. 18 patients (56.3%) had early rejection within the first 6 months. Treatment included methylprednisolone(72.2%), ATG(33.3%), apheresis (11.1%), rituximab(5.6%). CMV infection occurred in 44.4% of patients with early rejection vs. 50% of patients without. A total of 15 patients (46.9%) had CMV infection. 4 (26.7%) had recurrent infection. The median time for infection to occur post-transplant was 10 months (0-108 months). Of those with CMV infection, 5(33.3%) had donor positive(D+)/recipient positive(R+) status; 5 had D-/R+; 4 had D+/R- and 1 had D-/R- . Rejection occurred within 3 months prior to or at the time of CMV infection in 46.7% of patients. Concomitant infections occurred in 73.3% of patients. Treatment included ganciclovir(86.7%), CMV immunoglobulin(26.7%) and foscarnet (20%). IS was reduced following CMV infection in 40% of patients. There were no graft losses within 3 years post-transplant. 80% of patients with CMV infection survived to 3 years post-transplant vs. 76.5% of those without CMV. 2 patients had active CMV infection at the time of death, with one having disseminated disease.

*Conclusions: CMV is a common infection following IT and MVT. Concomitant infections are strongly associated with CMV. Decrease in prophylaxis and early rejection were not associated with higher likelihood of CMV infection. Further prospective studies are needed to determine optimal prophylactic and therapeutic approaches for CMV following IT and MVT.

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