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Cytomegalovirus infections in liver transplant recipients

Abstract number: R2273

Avkan-Oguz V., Unek T., Hancer M., Astarcioglu H., Karademir S.

Background and Objective: Cytomegalovirus (CMV) infections are the single most common viral infection since successful liver transplantation. The incidence of cytomegalovirus infections ranges 8–19% in seropositive liver transplant recipients (CMV R+). However it is vital that the centres have their own infection data profile. We aimed to find out viral infection incidence in liver transplant patients in DEU Hospital (Izmir/Turkey) in order to make a decision strategy for antiviral prophylaxis or preemptive therapy.

Methods: Between January 2003 and December 2007, 212 cases of liver transplantation were performed at our centre. Records of case were examined for risk factors of CMV infection retrospectively. Age, gender, MELD score, renal insufficiency, cold ischaemia time, bacterial and fungal infection, immunosuppressive therapy, massive blood transfusion, vascular and hepatic artery thrombosis, rejection were accepted as independent risk factors. None of the patients have received prophylaxis or preemptive treatment for CMV.

Results: In this study 99 (46, 7%) out of 212 patients were consulted to infectious disease and clinical microbiology specialists because of post-transplant infections and 20 (9, 4%) patients required antiviral treatment. Of 212 recipient, only 10 (4, 7%) were CMV seronegative. Of 20 patients used antiviral treatment, 12 (5, 7%) had Herpes simplex virus I/Varicella zoster virus infection and 8 (3, 7%) had CMV infection. Even there was no microbiological evidence, clinical response was determined with antiviral therapy in two cases with CMV infection. The details of six cases proven as CMV diseases are presented in table. All of these CMV cases had CMV R+ and were followed up by CMV antigenaemia assay. In the absence of effective antiviral prophylaxis or preemptive therapy, CMV infections usually occurred three months to six month following transplant surgery.

Conclusion: Upon analysis of viral infections our centre, the incidence of viral infections in liver transplant patients was found to be lower than expected and CMV diseases usually were the type of delayed-onset. According to these findings antiviral prophylaxis after transplantation is not recommended for the recipients in Dokuz Eylul University Hospital. However preemptive therapy should be used for those liver transplant recipient having high risk factors for CMV disease.

Table: The details of six cases proven CMV diseases

 Case ICase IICase IIICase IVCase VCase VI
Primary diseasesHepatitis BAlcoholismHepatitis CHepatitis BHepatitis B + minimal change diseaseHepatitis C
Age/gender66/M59/M58/F53/M41/F58/M
MELD score151914162018
Transplant typeCadavericLivingLivingCadavericLivingLiving
Renal insufficiency----Renal transplantation-
Cold ischaemia time (min)3701209033012090
Bacterial and fungal infection++----
ImmunosuppressionTacrolimusTacrolimusCiclosporinTacrolimusTacrolimusCiclosporin
 PrednisolonePrednisolonePrednisolonePrednisolonePrednisolonePrednisolone
 MMFMMFMMFMMFMMFMMF
Massive blood transfusion16644720
Vascular and hepatic artery thrombosis-+----
Rejection------
Date of CMV infection determinedSixth monthThird monthThird monthFirst monthFourth monthThird month
PrognosisExitusAliveAlive HCV nuksAliveAliveAlive HCV nuks

Session Details

Date: 16/05/2009
Time: 00:00-00:00
Session name: 19th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Helsinki, Finland, 16 - 19 May 2009
Presentation type:
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