1003. Baseline Absolute Lymphocyte Count is a Risk Factor for CMV Disease after Orthotopic Liver Transplantation
Session: Poster Abstract Session: CMV and Transplantation
Saturday, October 22, 2011
Room: Poster Hall B1


Background: Cytomegalovirus (CMV) disease, a feared complication of orthotopic liver transplantation (OLT), is thought to be related to the state of immunosuppression.  The best measure of immunosuppression after OLT has not been delineated.  One small study of OLT recipients showed a relationship between pre-transplant lymphocyte count and any infectious outcome.  We hypothesize that baseline lymphopenia increases the risk of CMV disease after OLT.

Methods:  We assessed baseline characteristics and predictors of CMV disease in a retrospective study of 282 consecutive OLTs performed between 2000 and 2007.  Those who received a second OLT >72 hours after primary OLT were excluded.  Universal CMV prophylaxis was given.  Lymphopenia (or neutropenia) was defined as absolute lymphocyte (or neutrophil) count (ALC or ANC, respectively) ≤ 500/mm3 within 24 hours prior to surgery.  CMV disease was defined as a mononucleosis-like syndrome or end-organ damage with laboratory or histological evidence of CMV.  Logistic regression was used to assess risk factors for CMV disease.  Statistical analysis was done with SAS, version 9.2 (Carey, NC).   

Results:  259 patients (181 males; 229 white, 3 black, 10 Hispanic, 4 Asian) were followed for ≥2 years or to death.  Median age was 52.4 years (range 0.30-68.9).  53 were D+/R+; 56 D+/R-; 77 D-/R+; 72 D-/R-.  Median ALC was 0.700 (range 0-7.00; 94 lymphopenic).  No patients were neutropenic.  CMV disease developed in 26 (10.0%, median of 163 days, range, 17-1435 days).  Age, gender, comorbidities, and neutropenia were not predictive of CMV disease; only lymphopenia, R CMV seropositivity, and D CMV seropositivity were significant in univariate analyses.  Moreover, R CMV seropositivity lost its significance when adjusted for lymphopenia while lymphopenia (adjusted OR, 3.02; 95% CI, 1.27 to 7.17; p = 0.01) and D CMV seropositivity (adjusted OR, 6.70; 95% CI, 2.41 to 18.6; p = 0.0003) were more significant in bivariate analysis. 

Conclusion: OLT recipients with lymphopenia prior to transplantation are at increased risk for CMV disease, independent of D/R serostatus.  Knowledge of this baseline parameter could play a dynamic role in determining post-OLT CMV prophylaxis on an individualized basis.

Subject Category: O. Transplant infectious diseases

Natalie E. Nierenberg, MD, MPH1, Debra D. Poutsiaka, MD, PhD2, Jennifer Chow, MD, MS3,4, Richard Rohrer, MD5, Jeffrey Cooper, MD5, Richard Freeman, MD5, Karen Curreri, RN, CCTC6 and David Snydman, MD, FIDSA2, (1)Infectious Disease, Tufts Medical Center, Boston, MA, (2)Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, (3)Tufts-New England Med Ctr, Boston, MA, (4)Tufts Medical Center, Boston, MA, (5)Tufts-New England Medical Center, Boston, MA, (6)Transplant Surgery, Tufts Medical Center, Boston, MA


N. E. Nierenberg, None

D. D. Poutsiaka, None

J. Chow, None

R. Rohrer, None

J. Cooper, None

R. Freeman, None

K. Curreri, None

D. Snydman, CSL Behring: Consultant and Speaker's Bureau, Consulting fee and Speaker honorarium

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.