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Trends in cytomegalovirus infection rate in liver transplant recipients and correlation with evolving recipient and donor characteristics



Trends in cytomegalovirus infection rate in liver transplant recipients and correlation with evolving recipient and donor characteristics



Abstracts of the Interscience Conference on Antimicrobial Agents & Chemotherapy 43: 500



Background: To determine whether recipient and donor characteristics that influence CMV infection rate after liver transplantation have changed. Methods: Recipient and donor characteristics (and other variables) that may affect CMV infection rate were assessed in 232 liver transplant recipients at our institution over a 14-year period (1989-2003). Chi square was used for trend analyses. Results: Since 1989, the age of the recipients (p=.0001) and that of the donors (p=.0001) has increased. Pretransplant CMV seropositivity in the recipients has decreased significantly (p=.0001, from 86.4% from 1989-92 to 53.7% from 2000-03) whereas donor CMV seropositivity has remained unchanged (p>0.20). As a result, there has been a significant increase in the proportion of high-risk (R-/D+) patients (p=.012); 10.6% of the recipients between 1989-92 vs. 24.1% between 2000-03 were R-/D+. The Child-Pugh scores of the recipients have remained unchanged over time. However, the proportion of patients transplanted while in the ICU has decreased significantly over time (p=.0002). The latter may have been a surrogate for lower pretransplant transfusion requirements and therefore lower CMV seropositivity in the recipients. A significant decrease in rejection rate and a trend towards an increase in CMV infection rate has occurred over time (p=.094). The incidence of CMV disease however, has decreased significantly (p=.0004, from 18.2% in 1989-92 to 0% in 2000-03) due largely to employment of preemptive therapy upon detection of asymptomatic antigenemia in the later years (prophylaxis for CMV infection has not been employed). Conclusions: The proportion of high-risk patients (CMV recipient-/donor+) has increased significantly over time, attributable largely to a declining rate of CMV seropositivity in the recipients prior to transplantation. These data have implications for guiding prophylactic practices and resource utilization after liver transplantation.

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