Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Background: Cytomegalovirus (CMV) is a common opportunistic infection after liver transplantation and is associated with significant morbidity and mortality. There are two strategies for preventing CMV disease: antiviral prophylaxis and preemptive therapy. The international consensus guidelines recommend antiviral prophylaxis for 3 months post-transplant in the high-risk recipients, with preemptive management as an alternative. However, the most appropriate strategy for CMV prevention in this population is still a matter of debate. Due to the significant hematologic toxicities and cost of antiviral prophylaxis, our institution utilizes a preemptive approach to CMV disease in our liver transplant population. The purpose of this study is to evaluate the efficacy of this practice.
Methods: This is a single-center retrospective chart review of all liver transplant recipients from November 1, 2008 through January 31, 2014. Patients were excluded from the analysis if they received valganciclovir as prophylaxis for CMV disease or the donor or recipient CMV serostatus was unknown.
Results: A total of 176 patients were included in the analysis. The overall incidence of CMV disease was 42% with a 55% incidence in the high risk population (D+/R-), 43.5% incidence in the intermediate risk population (D+/R+, D-/R+) and 5% incidence in the low risk population (D-/R-). The average time to onset of the first episode of CMV disease was 32 days post-transplantation. The incidence of recurrent CMV disease was highest in the high-risk population (20%) compared to the intermediate and low-risk populations (6% and 5%, respectively). Of the patients who developed CMV disease, the incidence of acute rejection was 15% compared to 18% in patients who did not develop CMV disease (p=NS). There was no significant difference in graft survival between the groups.
Conclusion: This study shows that preemptive therapy for CMV disease in liver transplant recipients is associated with a high incidence of CMV disease, especially in the high-risk patient population. However, the incidence of CMV disease did not result in increased risk of rejection or decrease graft survival.
To cite this abstract in AMA style:Alvey N, Tieman J, Diamond A, Hodowanec A, Simon D, Fayek S, Hertl M, Olaitan O, Hollinger E, Chan E. Preemptive Therapy for Cytomegalovirus Disease in Liver Transplant Recipients-A Single Center Experience [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/preemptive-therapy-for-cytomegalovirus-disease-in-liver-transplant-recipients-a-single-center-experience/. Accessed May 6, 2021.
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