Who among cytomegalovirus-seropositive liver transplant recipients is at risk for cytomegalovirus infection?

Abstract

A vast majority of the transplant recipients are cytomegalovirus (CMV)‐seropositive (R+). We sought to assess variables predictive of CMV infection, specifically in R+ liver transplant recipients. Study patients comprised 182 consecutive liver transplant recipients who survived at least 14 days after transplantation. Surveillance testing was used to detect CMV infection. Pre‐emptive therapy was employed for the prevention of CMV disease, however, no antiviral prophylaxis was used for CMV infection. CMV infection developed in 32.5% (38 of 117) of R+ patients, 84.6% (33 of 39) of R−/D+, and 3.8% (1 of 26) of R−/D− patients. In R+ patients, Hispanic race (21.6% vs. 7.8%, P = 0.06), donor CMV seropositivity (73.7% vs. 45.6%, P = 0.005), and hepatocellular carcinoma (23.7% vs. 6.3%, P = 0.05) correlated with a higher risk of CMV infection. In a multivariate model, Hispanic race (OR: 3.5, 95% CI: 1.03‐11.6, P = 0.045), donor CMV serostatus (OR: 4.0, 95% CI: 1.6‐10.2, P = 0.003) and hepatocellular carcinoma (OR: 5.8, 95% CI: 1.6‐20.5, P = 0.006) were all significant independent predictors of CMV infection. The aforementioned variables did not portend a higher risk of CMV infection in R−/D+ patients; donor CMV seropositivity overwhelmed all other risk factors in R− patients (P < 0.00001). In conclusion, CMV‐seropositive liver transplant recipients at risk for CMV infection can be identified based on readily assessable variables. Preventive strategies may be selectively targeted toward these patients. (Liver Transpl 2005;11:700–704.)