Introduction: CMV infection remains an important cause of morbidity, allograft enteritis, and allograft loss in small intestinal (SIT) and multivisceral transplant (MVT) recipients. As the highest risk for CMV infection is associated donor positive (D+) and recipient negative (R-) serostatus we have attempted to limit D+/R- SIT and MVT at our center.

Methods: We performed a retrospective analysis to determine whether a more restrictive donor selection criteria (i.e. limited D+/R- transplants) would affect the incidence of CMV infection in SIT and MVT recipients at our institution. All patients undergoing SIT or MVT from 2009-2016 (cohort A) were initially eligible; CMV infection/invasive disease incidence was determined during the first year post transplantation. This data was compared to a prior cohort B from 2003-2008 at our institution. Statistical significance was determined by Chi square and Fisher's Exact test.

Results: For cohort A, 136 SIT and MVT were performed. Out of these 11 were excluded due to re-transplantation and/or inadequate data. Types of transplant in the remaining 125 were: 81 isolated SIT, 22 SIT+liver transplant, 2 SIT+kidney, 20 MVT. CMV serostatus was as follows: D+/R- 15, D+/R+ 21, D-/R+ 16, D-/R- 73. We observed an overall mortality of 17.6% (22/125) for cohort A. CMV viremia/disease was seen in 11.2% (14/125) vs 18.2% (16/88) (p value 0.15) and invasive CMV disease was seen in 21.4% (3/14) vs 37.5% (6/16) (p value 0.44) for cohorts A and B, respectively. In patients with CMV infection/disease we observed a statistically significant difference for graft loss: 0% (0/14) vs 37.5% (6/16) (p value 0.02) and mortality: 14.3% (2/14) vs 56.3% (9/16) (p value 0.03) for cohorts A and B, respectively. Ganciclovir resistance (GCV-R) was seen in 7.1% (1/14) for cohort A vs 31.2% (5/16) (p value 0.18) for cohort B.

Conclusion: The use of restrictive donor selection criteria may reduce the burden of CMV infection in SIT and MVT recipients. As patients with short gut syndrome can be managed with TPN support, employment of a restrictive donor selection criteria to prevent CMV infection may reduce CMV associated allograft loss and mortality.

CITATION INFORMATION: Grewal H., Czech M., Matsumoto C., Natarajan M., Fraker J., Fan W., Timpone J. Cytomegalovirus (CMV) Infection in Small Intestinal and Multivisceral Transplant Recipients: The Role of Donor Selection on CMV Incidence and Outcomes Am J Transplant. 2017;17 (suppl 3).

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