Outcomes in High Risk CMV Liver Transplants with Elevated MELD Scores
1University of Maryland Medical Center, Baltimore, MD, 2University of Maryland School of Pharmacy, Baltimore, MD, 3University of Maryland School of Medicine, Baltimore, MD
Meeting: 2021 American Transplant Congress
Abstract number: 732
Keywords: Allocation, Cytomeglovirus, Infection, Prophylaxis
Topic: Clinical Science » Infectious Disease » All Infections (Excluding Kidney & Viral Hepatitis)
Session Information
Session Name: All Infections (Excluding Kidney & Viral Hepatitis)
Session Type: Poster Abstract
Session Date & Time: None. Available on demand.
Location: Virtual
*Purpose: There is inconclusive evidence on the impact of MELD score on CMV viremia after liver transplantation. Following the implementation of Share 35, liver transplant allocation to patients with MELD >35 significantly improved. This study assessed whether the risk of CMV viremia was increased in a high MELD (>35) cohort.
*Methods: This single center, retrospective, cohort study included liver transplant recipients from 2009 to 2019 who were at high risk for CMV (D+/R-). Patients were grouped by pre-transplant MELD score of <35 (low MELD) and >35 (high MELD). Patients received 3 months of CMV prophylaxis with valganciclovir. The primary endpoint was quantifiable CMV viremia by 12 months after transplant. Secondary endpoints were CMV tissue invasive disease, CMV resistance, BPAR, thrombocytopenia, leukopenia, and death. The Cox proportional hazards model was used to identify independent risk factors for CMV viremia.
*Results: A total of 244 patients were included. Differences in baseline characteristics (Table 1) were not predictive of CMV viremia, except for alcoholic cirrhosis (HR, 1.76; 95% CI, 1.09-2.85; p=0.02). More patients in the high MELD group developed CMV viremia (37% vs 26%); however, this was not statistically significant (HR, 1.6; 95% CI, 0.99-2.62; p=0.054). Following completion of valganciclovir prophylaxis, the mean time to CMV viremia was 162 + 61 and 139 + 62 in the low and high MELD groups, respectively (Figure 1). High rates of leukopenia and thrombocytopenia persisted through 6 months post-transplant (Table 2). Additionally, BPAR occurred early post-transplant in both the low and high MELD groups (median 31 days (13-62) vs 18 days (11-66); p=0.48) and was associated with an increased risk of CMV viremia (HR, 1.94; 95% CI, 1.2-3.15; p=0.007).
*Conclusions: Regardless of MELD score, 3 months of CMV prophylaxis results in high rates of CMV viremia, especially after BPAR episodes. Given persistent leukopenia and thrombocytopenia, improved surveillance strategies with routine monitoring of CMV may be preferred over extending the prophylaxis duration in this population.
To cite this abstract in AMA style:
Freedman S, Saunders K, Sparkes T, Masters B, Plazak M, Saharia K, Maluf D, Ravichandran B. Outcomes in High Risk CMV Liver Transplants with Elevated MELD Scores [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-in-high-risk-cmv-liver-transplants-with-elevated-meld-scores/. Accessed November 22, 2024.« Back to 2021 American Transplant Congress