TY - JOUR
T1 - Late cytomegalovirus disease following liver transplantation
AU - Shibolet, Oren
AU - Ilan, Yaron
AU - Kalish, Yosef
AU - Safadi, Rifaat
AU - Ashur, Yaffa
AU - Eid, Ahmed
AU - Shouval, Daniel
AU - Wolf, Dana
PY - 2003/12/1
Y1 - 2003/12/1
N2 - The widespread use of antiviral prophylaxis or preemptive therapy among orthotopic liver transplantation (OLT) recipients has reduced the occurrence of early cytomegalovirus (CMV) disease. Late disease is increasingly reported. Little is known about CMV disease occurring beyond the first year after transplantation. The aim of this study was to evaluate the occurrence of CMV disease two or more years after OLT and to determine its risk factors and clinical features. Eighty-one consecutive OLT recipients followed for 2 years or longer after transplantation were included in the study. Data were collected on demographic and clinical variables, clinical presentation, treatment, and outcome of late CMV disease. Late CMV disease occurred in 7/81 liver recipients (8.5%) at a mean time of 5.9 years after OLT (range: 3.5-9.3, median: 6.3 years). All seven patients were women, with a mean age of 47.7 years (range: 26-60, median: 59 years). There was no association between the development of late CMV disease and the occurrence of rejection episodes, treatment with corticosteroids, or the early use of antiviral prophylaxis. Clinical presentation included fever and disturbed liver functions in all patients, one patient had concurrent CMV pneumonitis and one CMV retinitis. Though all patients responded to ganciclovir, two had recurrent disease episodes and one patient died of secondary bacterial sepsis. Late-onset CMV disease can occur several years after OLT. Although it manifests classic clinical features of early disease, it is not associated with traditional risk factors and its pathogenesis may differ from that of early disease.
AB - The widespread use of antiviral prophylaxis or preemptive therapy among orthotopic liver transplantation (OLT) recipients has reduced the occurrence of early cytomegalovirus (CMV) disease. Late disease is increasingly reported. Little is known about CMV disease occurring beyond the first year after transplantation. The aim of this study was to evaluate the occurrence of CMV disease two or more years after OLT and to determine its risk factors and clinical features. Eighty-one consecutive OLT recipients followed for 2 years or longer after transplantation were included in the study. Data were collected on demographic and clinical variables, clinical presentation, treatment, and outcome of late CMV disease. Late CMV disease occurred in 7/81 liver recipients (8.5%) at a mean time of 5.9 years after OLT (range: 3.5-9.3, median: 6.3 years). All seven patients were women, with a mean age of 47.7 years (range: 26-60, median: 59 years). There was no association between the development of late CMV disease and the occurrence of rejection episodes, treatment with corticosteroids, or the early use of antiviral prophylaxis. Clinical presentation included fever and disturbed liver functions in all patients, one patient had concurrent CMV pneumonitis and one CMV retinitis. Though all patients responded to ganciclovir, two had recurrent disease episodes and one patient died of secondary bacterial sepsis. Late-onset CMV disease can occur several years after OLT. Although it manifests classic clinical features of early disease, it is not associated with traditional risk factors and its pathogenesis may differ from that of early disease.
KW - Cytomegalovirus
KW - Late infection
KW - Liver transplantation
UR - http://www.scopus.com/inward/record.url?scp=0347518998&partnerID=8YFLogxK
U2 - 10.1007/s00147-003-0643-x
DO - 10.1007/s00147-003-0643-x
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C2 - 12904846
AN - SCOPUS:0347518998
SN - 0934-0874
VL - 16
SP - 861
EP - 865
JO - Transplant International
JF - Transplant International
IS - 12
ER -