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Effect of Cytomegalovirus Infection Status on First-Year Mortality Rates among Orthotopic Liver Transplant Recipients

Matthew E. Falagas, MD, MSc; David R. Snydman, MD; John Griffith, PhD; Robin Ruthazer, MPH; and Barbara G. Werner, PhD
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The Boston Center for Liver Transplantation CMVIG Study Group*. From the New England Medical Center and the Massachusetts State Laboratory Institute, Boston, Massachusetts. *For members of the Boston Center for Liver Transplantation CMVIG Study Group, see the Appendix. Acknowledgment: The authors thank Roselia Martinez for preparation of the manuscript. Grant Support: In part by grant R10 DK31389 from the National Institutes of Health and a grant from MedImmune, Inc. (Gaithersburg, Maryland). Requests for Reprints: David R. Snydman, MD, New England Medical Center, Box 238, 750 Washington Street, Boston, MA 02111. Current Author Addresses: Drs. Falagas, Snydman, and Griffith and Ms. Ruthazer: New England Medical Center, 750 Washington Street, Boston, MA 02111.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;126(4):275-279. doi:10.7326/0003-4819-126-4-199702150-00003
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Background: To reduce the mortality rate associated with liver transplantation, it is important to identify the risk factors for increased mortality among liver transplant recipients. It has been suggested that cytomegalovirus (CMV) infection is one such risk factor, but no studies have examined mortality rates associated with the CMV serologic status of the donor and recipient by using multivariate techniques.

Objective: To study the effect of CMV on 1-year mortality rates in orthotopic liver transplant recipients.

Design: Intention-to-treat analysis of a cohort.

Patients: 146 liver transplant recipients who were enrolled in a multicenter, randomized, placebo-controlled, intervention trial.

Setting: Four university-affiliated transplantation centers.

Results: 1-year mortality rates for the four strata of donor and recipient CMV serologic status before transplantation were as follows: seronegative donor and recipient, 11%; seronegative donor and seropositive recipient, 22%; seropositive donor and recipient, 30%; and seropositive donor and seronegative recipient, 44% (P = 0.0091). Multivariate analysis using a time-dependent Cox proportional-hazards model showed that retransplantation (relative risk, 4.6 [95% CI, 1.9 to 10.7]; P < 0.001); total number of units of blood products administered during transplantation (relative risk, 1.006 per unit [CI, 1.003 to 1.010]; P < 0.001); and presence of CMV disease (relative risk, 3.9 [CI, 1.8 to 8.5]; P < 0.001), invasive fungal disease (relative risk, 3.3 [CI, 1.5 to 7.1]; P = 0.0020), and bacteremia (relative risk, 2.5 [CI, 1.2 to 5.2]; P = 0.0136) were independently associated with higher mortality rates. If post-transplantation variables that were highly correlated with donor and recipient CMV serologic status were restricted from the model, donor and recipient CMV serologic status was the only pretransplantation variable independently associated with higher mortality rates (P = 0.002).

Conclusion: Donor and recipient CMV serologic status is a significant pretransplantation determinant for death in liver transplant recipients.





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