PROGNOSTIC-SIGNIFICANCE AND RISK-FACTORS OF UNTREATED CYTOMEGALOVIRUSVIREMIA IN LIVER-TRANSPLANT RECIPIENTS

To study whether cytomegalovirus (CMV) viremia is a reliable marker of impending CMV disease and thus a guide for preemptive antiviral thera py, 126 consecutive liver transplant recipients were followed by routi ne CMV blood cultures in the absence of antiviral prophylaxis or treat ment for viremia, Seventy-three patients (58%) developed CMV infection s, and 36 (29%) had more than one infection episode: 29 patients (23%) had organ involvement and 45 (36%) had viremia. Within a same episode , CMV viremia was 90% sensitive and 80% specific for predicting concur rent organ involvement but preceded organ involvement in only 9 (31%) of 29 patients. In a separate analysis, untreated isolated CMV viremia in the first CMV infection episode was followed by organ involvement in a subsequent episode in 9 (33%) of 28 patients, mainly in the donor -positive, recipient-negative (D+/R-) population. The results indicate that CMV viremia is not an ideal marker to guide preemptive antiviral treatment in liver transplant recipients but is a good marker in D+/R -patients.