Impact of cytomegalovirus prophylaxis on rejection following orthotopic liver transplantation

Michelle Slifkin, Robin Ruthazer, Richard Freeman, Judy Bloom, Susan Fitzmaurice, Ralph B Fairchild, Michael Angelis, Jeffrey Cooper, Laurie Barefoot, Richard Rohrer, David R. Snydman

Research output: Contribution to journalArticlepeer-review

35 Scopus citations

Abstract

With improved cytomegalovirus (CMV) prophylaxis, CMV disease after liver transplantation has decreased dramatically, and patient and graft survival have improved. We examined the impact of CMV prophylaxis on biopsy proven rejection after orthotopic liver transplantation by analyzing data on 192 liver recipients over 5 years (1994-1999). Risk factors assessed for biopsy proven rejection including donor and recipient age, CMV serostatus; CMV prophylaxis; immunosuppression; bacteremia and blood product use were examined over a 2-year follow-up. Multivariate analysis of risk factors for rejection showed that bacteremia (HR 3.57, 95% CI 1.39-9.36, P=0.008), donor age (HR 1.20, 95% CI 1.06-1.36, per 10 year increase, P=0.004), and use of cyclosporine as initial immunosuppression compared to tacrolimus (HR 1.98, 95% CI 1.27-3.09, P=0.003) were associated with increased risk; ganciclovir prophylaxis for 3 months (HR 0.51, 95% CI 0.33 to 0.79, P=0.003) and recipient age (HR 0.78; 95% CI 0.63-0.96, for each 10 year increase, P=0.03) were associated with decreased risk. We conclude that, the use of CMV prophylaxis with ganciclovir significantly reduces the incidence of biopsy proven rejection in liver transplant recipients.

Original languageEnglish (US)
Pages (from-to)1597-1602
Number of pages6
JournalLiver Transplantation
Volume11
Issue number12
DOIs
StatePublished - Dec 1 2005

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