Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2016; 22(12): 3412-3417
Published online Mar 28, 2016. doi: 10.3748/wjg.v22.i12.3412
Two strategies for prevention of cytomegalovirus infections after liver transplantation
Philipp Simon, Max Sasse, Sven Laudi, David Petroff, Michael Bartels, Udo X Kaisers, Sven Bercker
Philipp Simon, Max Sasse, Sven Laudi, Udo X Kaisers, Sven Bercker, Department of Anesthesia and Intensive Care Medicine, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
David Petroff, Clinical Trial Centre Leipzig, University of Leipzig, 04103 Leipzig, Germany
Michael Bartels, Department of Visceral, Transplantation, Vascular and Thoracic Surgery, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
Author contributions: Simon P and Bercker S designed research; Simon P and Sasse M performed research; Simon P and Bercker S contributed new reagents or analytic tools; Simon P, Sasse M and Petroff D analyzed data; Simon P, Petroff D, Bercker S, Laudi S, Bartels M and Kaisers UX wrote the paper.
Institutional review board statement: This study was reviewed and approved by the institutional review board of the University of Leipzig, Germany.
Informed consent statement: The institutional review board of the University of Leipzig waived the need for informed consent due to the strongly retrospective and observational nature of the study.
Conflict-of-interest statement: On behalf of all authors, the corresponding author states that there is no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Philipp Simon, MD, Department of Anesthesia and Intensive Care Medicine, Medical Faculty, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany. philipp.simon@medizin.uni-leipzig.de
Telephone: +49-341-971700 Fax: +49-341-9717709
Received: May 17, 2015
Peer-review started: May 20, 2015
First decision: July 19, 2015
Revised: September 30, 2015
Accepted: November 30, 2015
Article in press: December 1, 2015
Published online: March 28, 2016
Processing time: 310 Days and 17.2 Hours
Abstract

AIM: To analyze differences in patients’ clinical course, we compared two regimes of either preemptive therapy or prophylaxis after liver transplantation.

METHODS: This retrospective study was reviewed and approved by the institutional review board of the University of Leipzig. Cytomegalovirus (CMV) prophylaxis with valganciclovir hydrochloride for liver transplant recipients was replaced by a preemptive strategy in October 2009. We retrospectively compared liver transplant recipients 2 years before and after October 2009. During the first period, all patients received valganciclovir daily. During the second period all patients included in the analysis were treated following a preemptive strategy. Outcomes included one year survival and therapeutic intervention due to CMV viremia or infection.

RESULTS: Between 2007 and 2010 n = 226 patients underwent liver transplantation in our center. n = 55 patients were D+/R- high risk recipients and were excluded from further analysis. A further 43 patients had to be excluded since CMV prophylaxis/preemptive strategy was not followed although there was no clinical reason for the deviation. Of the remaining 128 patients whose data were analyzed, 60 received prophylaxis and 68 were treated following a preemptive strategy. The difference in overall mortality was not significant, nor was it significant for one-year mortality where it was 10% (95%CI: 8%-28%, P = 0.31) higher for the preemptive group. No significant differences in blood count abnormalities or the incidence of sepsis and infections were observed other than CMV. In total, 19 patients (14.7%) received ganciclovir due to CMV viremia and/or infections. Patients who were treated according to the preemptive algorithm had a significantly higher rate risk of therapeutic intervention with ganciclovir [n = 16 (23.5%) vs n = 3 (4.9%), P = 0.003)].

CONCLUSION: These data suggest that CMV prophylaxis is superior to a preemptive strategy in patients undergoing liver transplantation.

Keywords: Transplantation; Liver; Cytomegalovirus; Preemptive; Prophylaxis; Valganciclovir; Therapy

Core tip: This retrospective study compares a preemptive therapy to prophylaxis for cytomegalovirus (CMV) infection in 128 patients after liver transplantation (LTx). CMV infections are frequent and increase morbidity and mortality so that preventive strategies are routine procedures. The one-year mortality did not differ significantly between the preemptive (n = 68) and prophylaxis (n = 60) groups, though it was 10% (95%CI: 8%-28%, P = 0.31) higher for the former. Preemptive patients had a significantly higher rate of intervention with ganciclovir (23.5% vs 4.9%, P = 0.003). Our data suggest that CMV prophylaxis is superior to a preemptive strategy after LTx.