Risk Factors for Cytomegalovirus Viremia following Liver Transplantation With a Seropositive Donor and Seronegative Recipient Receiving Antiviral Therapy

• Published in: The Journal of infectious diseases 2021-03, Vol.223 (6), p.1073-1077
• Main Authors: Singh, Nina, Winston, Drew J, Razonable, Raymund R, Lyon, G Marshall, Silveira, Fernanda P, Wagener, Marilyn M, Limaye, Ajit P
• Format: Article
• Language: English
• Subjects: Age; Age Factors; Antiviral agents; Antiviral Agents - therapeutic use; Antiviral drugs; Cytomegalovirus; Cytomegalovirus Infections - drug therapy; DNA-directed DNA polymerase; Ganciclovir - therapeutic use; Humans; Liver Transplantation; Liver transplants; Major and Brief Reports; Polymerase chain reaction; Population studies; Prophylaxis; Regression analysis; Risk Factors; Tissue Donors; Viremia; Viremia - drug therapy
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jiaa470

Abstract Background The risk factors for development of viremia in high-risk donor cytomegalovirus (CMV)-seropositive and recipient CMV-seronegative (D+R−) transplant recipients are incompletely defined. Methods The study population comprised patients in the preemptive therapy (PET) arm of a randomized, controlled trial of PET versus prophylaxis using valganciclovir in D+R− liver transplant recipients. Weekly surveillance monitoring for viremia for 100 days was performed using a sensitive CMV-DNA polymerase chain reaction assays. Risk factors for viremia and time to onset (≤4 vs >4 weeks) of viremia were examined using logistic regression models. Results Viremia developed in 84% (79/94) of recipients and older donor age was the only independent factor associated with viremia (odds ratio, 2.20 for each quartile increase in donor age; 95% confidence interval [CI], 1.07–4.52; P = .031). Recipients who developed early-onset viremia (within 4 weeks) also had significantly older donors than those with later-onset viremia (difference in age 10.1 years; 95% CI, 2–19; P = .03). Conclusions Older donor age was an independent predictor of viremia and earlier-onset of viremia in D+R− liver transplant recipients. Future studies should assess the mechanistic links underlying this novel association. Clinical Trial Registration NCT01552369. Older donor age is independently associated with cytomegalovirus viremia and earlier onset of viremia in high-risk donor-positive recipient-negative liver transplant recipients.