1748. Incidence of Cytomegalovirus Disease and Viral Replication Kinetics in Intermediate Risk Liver Transplant Recipients Managed According to a Preemtive Therapy Algortihm

Abstract Background Cytomegalovirus (CMV) is an important opportunistic pathogen in liver transplant recipients (LTR). Risk of invasive disease is determined by CMV donor/recipient (D/R) serostatus, immunosuppression, and use of antiviral prophylaxis. Viral replication kinetics that can predict the development of CMV disease in transplant recipients are a high maximal viral load (VL) and a fast replication velocity. At our institution LTR at intermediate risk for CMV disease (CMV D/R+) are managed following a preemptive therapy algorithm (the pre-established cutoff for treatment initiation is 4,000 IU/mL). The primary endpoint of this study was to determine the incidence of early CMV disease in CMV D/R+ LTR. Secondary endpoints were to calculate the period of maximal VL and viral kinetic parameters. Methods We performed a retrospective observational study of CMV D/R+ LTR. Patients were followed for 6 months after transplantation. We calculated the incidence of CMV disease. Viral kinetic parameters calculated were the VL duplication time (Td) and the basic reproductive number (R0). For the assessment of viral kinetics we used the maximal VL of 10 patients who had a VL determined within the previous week. Results Forty CMV D/R+ LTR were included. The median age was 52 years, 65% were women. The mean MELD score was 18, 83% of patients had decompensated cirrhosis. No patient developed CMV disease during the first 6 months after LT. Nineteen patients (47%) had CMV DNAemia, but only 8 (20%) required antiviral therapy. The highest VLs were observed during the second month after transplant. The median duplication time was 2.14 days. The median R0 was 1.46. Conclusion Although limited by our sample size, our algorithm appears useful for discriminating the patients who need antiviral treatment from those who will only have asymptomatic DNAemia. The study population VL, Td and R0 behave as described by other groups, which emphasizes the need for frequent monitoring. This is a challenge for CMV prevention in resource-limited countries. Disclosures All authors: No reported disclosures.

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CMV Antigenemia Directed Preemptive Prophylaxis with Oral Ganciclovir for the Prevention of CMV Disease in Liver Transplant Recipients: A Prospective, Randomized, Controlled Trial.

Transplantation Journal ◽

10.1097/00007890-199805131-00440 ◽

1998 ◽

Vol 65 (Supplement) ◽

pp. 189

Author(s):

N SINGH ◽

V L YU ◽

T GAYOWSKI ◽

I R MARINO

Keyword(s):

Randomized Controlled Trial ◽

Liver Transplant ◽

Controlled Trial ◽

Oral Ganciclovir ◽

Transplant Recipients ◽

Randomized Controlled ◽

Prospective Randomized Controlled Trial ◽

Cmv Disease ◽

Liver Transplant Recipients ◽

Cmv Antigenemia

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Prevalence of Invasive Cytomegalovirus Disease with Administration of Muromonab Cd-3 in Patients Undergoing Orthotopic Liver Transplantation

Annals of Pharmacotherapy ◽

10.1177/106002809202600501 ◽

1992 ◽

Vol 26 (5) ◽

pp. 617-620 ◽

Cited By ~ 15

Author(s):

Michael A. Hooks ◽

Carl A. Perlino ◽

J. Michael Henderson ◽

William J. Millikan ◽

Michael H. Kutner

Keyword(s):

Liver Transplant ◽

Data Extraction ◽

Transplant Recipients ◽

Early Administration ◽

Administration Time ◽

Study Population ◽

Cmv Disease ◽

Liver Transplant Recipients ◽

The Relationship ◽

Postoperative Administration

OBJECTIVE: To assess the association of cytomegalovirus (CMV) disease with the administration of muromonab CD-3 (OKT-3) in patients undergoing liver transplant; specifically, to assess the risk of OKT-3 use as an agent for rejection prophylaxis and as an agent for therapy of rejection. DESIGN: Retrospective review of medical records. STUDY POPULATION: 83 liver transplant recipients (43 men, 40 women) with a mean age of 41.5 years (range 16–62). DATA EXTRACTION: The medical record for each liver transplant recipient was reviewed and analyzed for the following variables: (1) preoperative recipient CMV serology, (2) donor CMV serology, (3) incidence of invasive CMV disease, (4) administration of OKT-3, (5) postoperative administration time of OKT-3, and (6) the relationship between the administration of OKT-3 and the prevalence of invasive CMV disease. RESULTS: OKT-3 was administered to 34 of 83 (40.9 percent) liver recipients, 7 of whom received OKT-3 as rejection prophylaxis; the remainder received OKT-3 as rejection rescue. All patients received OKT-3 5 mg iv for 14 days. Seventeen of the 34 patients receiving OKT-3 (50 percent) developed invasive CMV disease; 58.8 percent of the patients (20/34) receiving OKT-3 were given the agent within the first 14 postoperative days. Sixteen of these 20 patients (80 percent) developed invasive CMV disease. One of 14 patients (7.1 percent) who received OKT-3 after the first 14 postoperative days developed invasive CMV disease. Of those patients 94 percent (16/17) received OKT-3 in the first 14 postoperative days. This prevalence differed significantly from those receiving OKT-3 after the 14th postoperative day and those who did not receive OKT-3 at any time during their hospital course. CONCLUSIONS: The patients who received early administration of OKT-3 in our study had a greater risk of invasive CMV disease than did those who received OKT-3 later in the hospital course.

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