Purpose: CMV remains a common complication of liver transplantation, and its direct and indirect effects contribute greatly to the morbidity and mortality in this patient population. Current guidelines do not give strong recommendations regarding the preferred strategy, agent, or duration of prophylaxis for liver transplant recipients. The objective of this study is to determine a preferred CMV preventative strategy among two protocols used at different time points at our institution.

Methods: Patients were included in this single center, retrospective study if they underwent liver transplantation between January 1, 2007 and December 31, 2009, were of CMV intermediate- or high-risk status, and were at least 18 years of age. Patients were compared on a 1:1 basis between the two preventative protocols termed old protocol (OP) and new protocol (NP). The OP utilized before July 1, 2008 consisted of solely giving valganciclovir 900mg daily x 3 months, followed by 450mg daily x 3 months in high-risk patients. The NP employed valganciclovir 900mg daily x 3 months, followed by 450mg daily x 6 additional months for high-risk recipients and 6 months of valganciclovir 450mg daily to the intermediate-risk group. The final analysis included 97 patients in each protocol group. The primary outcome was the development of CMV viremia within one year post-prophylaxis use. Secondary outcomes included: incidence of invasive CMV disease, time to CMV viremia, and incidence of infection, rejection, malignancy, and mortality.

Results: Incidence of CMV was 20 (20.6%) in the OP as compared with 8 (8.2%) in the NP (p=0.01). Invasive CMV disease occurred in three cases (1.5%) of the total population, one case in the NP vs. two in the OP (p>0.99). Time to CMV viremia development was significantly prolonged in the NP group compared to the OP group (8.6 months from 2.6 months, p<0.01). No differences were found in other outcomes between groups including incidence of infection (p=0.55), rejection (p=0.47), onset of new malignancy (p=0.72), or mortality (p=0.49). No death during the study was attributable to CMV or related causes.

Conclusion: Use of the updated CMV prophylaxis protocol decreased the incidence of CMV viremia and prolonged the time to development of CMV. Use of a protocol consisting of high dose valganciclovir and prolonged prophylaxis is effective at reducing CMV, and should be considered at other centers.

« Back to 2013 American Transplant Congress