Incidence and predictors of cytomegalovirus pneumonia in orthotopic liver transplant recipients

Matthew E. Falagas, David R. Snydman, Marie J. George, Barbara Werner, Robin Ruthazer, John Griffith, Richard H. Rohrer, Richard Freeman, Karim Fawaz, Mark A. Hoffman, Marshall Kaplan, Maura Gill, Robert H. Rubin, Jules L. Dienstag, Maureen Doran, Edward O'Rourke, Joseph Vacanti, Roger Jenkins, W. David Lewis, Scott HammerMaureen Martin, Ralph Fairchild, George F. Grady, Jeanne Leszczynski, Nancy Dougherty, Andrea Katz, Gary Fausett, Richard Platt, Sarah H. Cheeseman, Mark Pasternack, Sherwood L. Gorbach

Research output: Contribution to journalArticle

31 Scopus citations

Abstract

The incidence, predictors, and outcome of cytomegalovirus pneumonia in OLT recipients have not been well defined. We conducted an analysis of prospectively collected data from 141 OLT recipients who were included as part of a randomized, placebo-controlled trial of CMV immune globulin prophylaxis. Cytomegalovirus pneumonia was diagnosed in 13 of 141 (9.2%) OLT recipients during the first year posttransplant and was associated with a higher 1-year mortality compared with those recipients without CMV pneumonia (84.6 vs. 17.2%, P=0.0001). Univariate analysis demonstrated that CMV viremia (P=0.001), invasive fungal disease (P=0.0001), donor(+)/pretransplant recipient(-) CMV serologic status (P=0.013), abdominal operation (excluding retransplantation) after liver transplantation (P=0.0027), bacteremia (P=0.0105), and advanced United Network of Organ Sharing status (P=0.023) were associated with CMV pneumonia. Cytomegalovirus viremia was diagnosed in 11 of 13 patients with CMV pneumonia at a median of 11 days (range 1-66 days) before diagnosis of CMV pneumonia. In a multivariate analysis using a time- dependent, Cox proportional hazards model, CMV viremia (RR=8.6, 95% CI 1.8- 39.7, P=0.0012), invasive fungal disease (RR=6.5, 95% CI 2.1-20.3, P=0.0001), and abdominal reoperation (RR=4.4, 95% CI 1.4-13.1, P=0.0043) were found to be independent predictors of CMV pneumonia. The attributable mortality associated with CMV pneumonia within the first year after liver transplantation for the patients with CMV pneumonia was 67.4%. Intensified measures for prevention of CMV should be considered for patients at high risk of developing CMV pneumonia.

Original languageEnglish (US)
Pages (from-to)1716-1720
Number of pages5
JournalTransplantation
Volume61
Issue number12
DOIs
StatePublished - Jun 27 1996

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