TY - JOUR
T1 - Incidence and predictors of cytomegalovirus pneumonia in orthotopic liver transplant recipients
AU - Falagas, Matthew E.
AU - Snydman, David R.
AU - George, Marie J.
AU - Werner, Barbara
AU - Ruthazer, Robin
AU - Griffith, John
AU - Rohrer, Richard H.
AU - Freeman, Richard
AU - Fawaz, Karim
AU - Hoffman, Mark A.
AU - Kaplan, Marshall
AU - Gill, Maura
AU - Rubin, Robert H.
AU - Dienstag, Jules L.
AU - Doran, Maureen
AU - O'Rourke, Edward
AU - Vacanti, Joseph
AU - Jenkins, Roger
AU - Lewis, W. David
AU - Hammer, Scott
AU - Martin, Maureen
AU - Fairchild, Ralph
AU - Grady, George F.
AU - Leszczynski, Jeanne
AU - Dougherty, Nancy
AU - Katz, Andrea
AU - Fausett, Gary
AU - Platt, Richard
AU - Cheeseman, Sarah H.
AU - Pasternack, Mark
AU - Gorbach, Sherwood L.
PY - 1996/6/27
Y1 - 1996/6/27
N2 - The incidence, predictors, and outcome of cytomegalovirus pneumonia in OLT recipients have not been well defined. We conducted an analysis of prospectively collected data from 141 OLT recipients who were included as part of a randomized, placebo-controlled trial of CMV immune globulin prophylaxis. Cytomegalovirus pneumonia was diagnosed in 13 of 141 (9.2%) OLT recipients during the first year posttransplant and was associated with a higher 1-year mortality compared with those recipients without CMV pneumonia (84.6 vs. 17.2%, P=0.0001). Univariate analysis demonstrated that CMV viremia (P=0.001), invasive fungal disease (P=0.0001), donor(+)/pretransplant recipient(-) CMV serologic status (P=0.013), abdominal operation (excluding retransplantation) after liver transplantation (P=0.0027), bacteremia (P=0.0105), and advanced United Network of Organ Sharing status (P=0.023) were associated with CMV pneumonia. Cytomegalovirus viremia was diagnosed in 11 of 13 patients with CMV pneumonia at a median of 11 days (range 1-66 days) before diagnosis of CMV pneumonia. In a multivariate analysis using a time- dependent, Cox proportional hazards model, CMV viremia (RR=8.6, 95% CI 1.8- 39.7, P=0.0012), invasive fungal disease (RR=6.5, 95% CI 2.1-20.3, P=0.0001), and abdominal reoperation (RR=4.4, 95% CI 1.4-13.1, P=0.0043) were found to be independent predictors of CMV pneumonia. The attributable mortality associated with CMV pneumonia within the first year after liver transplantation for the patients with CMV pneumonia was 67.4%. Intensified measures for prevention of CMV should be considered for patients at high risk of developing CMV pneumonia.
AB - The incidence, predictors, and outcome of cytomegalovirus pneumonia in OLT recipients have not been well defined. We conducted an analysis of prospectively collected data from 141 OLT recipients who were included as part of a randomized, placebo-controlled trial of CMV immune globulin prophylaxis. Cytomegalovirus pneumonia was diagnosed in 13 of 141 (9.2%) OLT recipients during the first year posttransplant and was associated with a higher 1-year mortality compared with those recipients without CMV pneumonia (84.6 vs. 17.2%, P=0.0001). Univariate analysis demonstrated that CMV viremia (P=0.001), invasive fungal disease (P=0.0001), donor(+)/pretransplant recipient(-) CMV serologic status (P=0.013), abdominal operation (excluding retransplantation) after liver transplantation (P=0.0027), bacteremia (P=0.0105), and advanced United Network of Organ Sharing status (P=0.023) were associated with CMV pneumonia. Cytomegalovirus viremia was diagnosed in 11 of 13 patients with CMV pneumonia at a median of 11 days (range 1-66 days) before diagnosis of CMV pneumonia. In a multivariate analysis using a time- dependent, Cox proportional hazards model, CMV viremia (RR=8.6, 95% CI 1.8- 39.7, P=0.0012), invasive fungal disease (RR=6.5, 95% CI 2.1-20.3, P=0.0001), and abdominal reoperation (RR=4.4, 95% CI 1.4-13.1, P=0.0043) were found to be independent predictors of CMV pneumonia. The attributable mortality associated with CMV pneumonia within the first year after liver transplantation for the patients with CMV pneumonia was 67.4%. Intensified measures for prevention of CMV should be considered for patients at high risk of developing CMV pneumonia.
UR - http://www.scopus.com/inward/record.url?scp=8944245854&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=8944245854&partnerID=8YFLogxK
U2 - 10.1097/00007890-199606270-00009
DO - 10.1097/00007890-199606270-00009
M3 - Article
C2 - 8685949
AN - SCOPUS:8944245854
SN - 0041-1337
VL - 61
SP - 1716
EP - 1720
JO - Transplantation
JF - Transplantation
IS - 12
ER -