1001. Antiviral Prophylaxis versus Pre-emptive Therapy to Prevent CMV Infection and Related Death in Liver Transplantation: A Retrospective Cohort Study with Propensity Score Matching
Session: Poster Abstract Session: CMV and Transplantation
Saturday, October 22, 2011
Room: Poster Hall B1
Background:

Cytomegalovirus (CMV) is the most common and significant viral infection in individuals who have undergone liver transplantation. Most centers use one of two preventive methods: universal prophylaxis (UP) or preemptive therapy (PE). A more effective method for prevention of CMV diseases has not yet been discovered.

Methods: 

Medical records of patients who underwent liver transplantation from 2007 to 2009 in three tertiary hospitals were reviewed. Pre-emptive therapy was used in two hospitals (PE group), whereas universal prophylaxis with valganciclovir for three months was the method of choice in the remaining hospital (UP group). The two groups were matched using propensity scoring by preoperative, and perioperative variables. After matching the two groups, a 1:1 comparison of the efficacy of UP and PE was performed.

Results: 

A total of 634 patients underwent liver transplantation; 562 were matched. Baseline characteristics and underlying liver status between the groups were comparable. CMV viremia that required antiviral treatment occurred in 37 (13.2%) patients in the UP group and in 26 (9.3%) in the PE group (p = 0.181). CMV-related mortality rates were similar in both groups (1.8 vs. 0.7%, p = 0.450), but all-cause mortality was higher in the PE group (13.2 vs. 18.5%; p = 0.083)

Conclusion: 

The efficacy of PE is similar to that of UP in preventing CMV disease and CMV-related mortality.
UP group PE group p value
CMV viremia 42 (14.9%) 32 (11.4%) 0.261
CMV viremia that required antiviral treatment 37 (13.2%) 26 (9.3%) 0.181
Spontaneously dissolved CMV viremia 5 (1.8%) 6 (2.1%) 0.761
CMV related death 5 (1.8%) 2 (0.7%) 0.450

 


Subject Category: O. Transplant infectious diseases

Chung-Jong Kim, MD1, Heejung Son, MS1, Young-Eun Kim1, Myoung Soo Kim, MD, PhD2, Shin Hwang, MD, PhD3, Ji Il Kim, MD, PhD4 and Sang Il Kim, MD5, (1)National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea, (2)Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea, (3)Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, (4)Department of Surgery, The Catholic University of Korea, Seoul, South Korea, (5)Catholic medical university, Seoul, South Korea

Disclosures:

C. J. Kim, None

H. Son, None

Y. E. Kim, None

M. S. Kim, None

S. Hwang, None

J. I. Kim, None

S. I. Kim, None

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