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Detrimental impact of immunosuppressive burden on clinical course in patients with Cytomegalovirus infection after liver transplantation

Introduction Cytomegalovirus (CMV)-infection and reactivation remain a relevant complication after liver transplantation (LT). The recipient and donor serum CMV-IgG-status has been established for risk stratification when choosing various pharmaceutical regimens for CMV-prophylaxis in the last two d...

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Main Authors: Ossami Saidy, Ramin Raul (Author) , Kollar, Stefanie (Author) , Czigány, Zoltán (Author) , Dittrich, Luca (Author) , Raschzok, Nathanael Johannes (Author) , Globke, Brigitta (Author) , Schöning, Wenzel (Author) , Öllinger, Robert (Author) , Lurje, Georg (Author) , Pratschke, Johann (Author) , Eurich, Dennis (Author) , Uluk, Deniz (Author)
Format: Article (Journal)
Language:English
Published: 27 November 2023
In: Transplant infectious disease
Year: 2024, Volume: 26, Issue: 1, Pages: 1-14
ISSN:1399-3062
DOI:10.1111/tid.14196
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1111/tid.14196
Verlag, lizenzpflichtig, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1111/tid.14196
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Author Notes:Ramin Raul Ossami Saidy, Stefanie Kollar, Zoltan Czigany, Luca Dittrich, Nathanael Raschzok, Brigitta Globke, Wenzel Schöning, Robert Öllinger, Georg Lurje, Johann Pratschke, Dennis Eurich, Deniz Uluk
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Summary:Introduction Cytomegalovirus (CMV)-infection and reactivation remain a relevant complication after liver transplantation (LT). The recipient and donor serum CMV-IgG-status has been established for risk stratification when choosing various pharmaceutical regimens for CMV-prophylaxis in the last two decades. However, factors influencing course of CMV-infection in LT remain largely unknown. In this study, the impact of immunosuppressive regimen was examined in a large cohort of patients. Methods All patients that underwent primary LT between 2006 and 2018 at the Charité-Universitaetsmedizin, Berlin, were included. Clinical course as well as histological and laboratory findings of patients were analyzed our prospectively maintained database. Univariate and multivariate regression analysis for impact of variables on CMV-occurrence was conducted, and survival was examined using Kaplan-Meier analysis. Results Overall, 867 patients were included in the final analysis. CMV-infection was diagnosed in 325 (37.5%) patients after transplantation. Significantly improved overall survival was observed in these patients (Log rank = 0.03). As shown by correlation and regression tree classification and regression tree analysis, the recipient/donor CMV-IgG-status with either positivity had the largest influence on CMV-occurrence. Analysis of immunosuppressive burden did not reveal statistical impact on CMV-infection, but statistically significant inverse correlation of cumulative tacrolimus trough levels and survival was found (Log rank < .001). Multivariate analysis confirmed these findings (p = .02). Discussion CMV-infection remains of clinical importance after LT. Undergone CMV-infection of either recipient or donor requires prophylactic treatment. Additionally, we found a highly significant, dosage-dependent impact of immunosuppression (IS) on long-term outcomes for these patients, underlying the importance of minimization of IS in liver transplant recipients.
Item Description:Gesehen am 27.05.2024
Physical Description:Online Resource
ISSN:1399-3062
DOI:10.1111/tid.14196

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