Prevention strategies against CMV-infection after liver transplantation
Armin Belarmino1, Daniela Kniepeiss1, Marie-Therese Fleischhacker1, Regina Riedl2, Astrid Mandl-Pohl2, Helmut Müller1, Peter Schemmer1.
1General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria; 2Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Graz, Austria
Background: There is a variety of prevention strategies against cytomegalovirus (CMV) viremia / disease after liver transplantation (LT). Thus, this retrospective cohort study performed in a prospective manner with a 1-year follow-up has been performed comparing anti-CMV immunoglobulins (IGs) with Valganciclovir.
Patients and Methods: A total of 257 patients underwent LT between January 2008 and May 2020. While 134 patients received anti-CMV-IGs (7500 IU for 4 days) between 2008 and October 2016, 111 patients were treated with Valganciclovir (up to 900 mg/d for 3-6 months dependent on renal function and side effects) since November 2016. Patients with viremia in both groups were treated at least for 14 days with Ganciclovir or Valganciclovir. Primary endpoint of the study was CMV viremia within 1 year after LT. Secondary endpoints were leukopenia, renal function, patient and graft survival.
Results: Demographics were comparable in both groups (i.e. age (56.6 +/- 11.2 years), gender (78.8% male)). Viremia was 36.7% (n=90) within 1 year after LT with 43.3% (n=58) after anti-CMV IGs vs. 28.8% (n=32) after Valganciclovir (p>0.05). The incidence of viremia was dependent of the donor-recipient match with 39.6% (n=21) and 60,6% (n=20) in D-/R+ and D+/R+ after anti-CMV IGs, and 12.0% (n=3) and 25,7% (n=9) after Valganciclovir (p=0.018; p=0.007), respectively. The overall 1-year mortality rate was comparable in both groups with 13.1% (n=32). Kidney function based on serum creatinine was significantly improved with anti-CMV IGs at 1 year after LT.
Conclusion: While Valgancyclovir protected nicely CMV positive recipients from CMV viremia the effect of anti-CMV IGs was inferior in this constellation without any impact on CMV disease; however, anti-CMV IGs are in favor to a better side effect profile especially concerning renal function and thus it should be the preferred prevention strategy.
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