399. Clinical Outcomes without CMV Prophylaxis in Living-donor Liver Transplant Recipients in Korea
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Meta-analysis showed that prophylaxis being preferred than preemptive therapy for CMV disease after liver transplantation. However, in Korea, prophylactic ganciclovir is not covered by insurance even in patients with D+/R+ serostatus. Considering that 98% of patients are seropositive for CMV and living donors contribute to 90% of liver transplants, effect of CMV reactivation without prophylaxis needs to be evaluated.
Methods: We retrospectively analyzed 92 consecutive living-donor liver transplant recipients from October 2007 to April 2009. Patients were divided into two groups according to with or without episode of CMV viremia. Quantitative real-time PCR was used and clinical outcomes were analyzed.
Results: Mean follow up periods were 30 days (3 to 156 days). Among 92 recipients, 21.7% (20/92) had CMV reactivation. Total five patients were died, among them four patients had episode of CMV reactivation (20% [4/20] vs 1.4% [1/72]; OR=17.5, P=0.001). None of them had proven tissue invasive CMV disease. Multiple logistic regression analysis identified the administration of tacrolimus was the only independent risk factor for CMV reactivation (OR=0.048, P=0.039). Univariate analysis showed patients with CMV showed longer hospital stay (52.3 ± 20.1 days vs 35.1 ± 13.1 days, P<0.0015).
Conclusions: Our data showed that despite the preemptive therapy, recipients with episode of CMV reactivation showed higher mortality and longer hospital stay. Antiviral prophylaxis should be considered in living donor liver transplant recipients with seropositive for CMV.
Kyung-Wook Hong, MD and  K. Hong, None.