INCIDENCE AND PREDICTORS OF CYTOMEGALOVIRUS PNEUMONIA IN ORTHOTOPIC LIVER-TRANSPLANT RECIPIENTS

The incidence, predictors, and outcome of cytomegalovirus pneumonia in OLT recipients have not been well defined. We conducted an analysis o f prospectively collected data from 141 OLT recipients who mere includ ed as part of a randomized, placebo-controlled trial of CMV immune glo bulin prophylaxis. Cytomegalovirus pneumonia was diagnosed in 13 of 14 1 (9.2%) OLT recipients during the first year posttransplant and was a ssociated with a higher 1-year mortality compared with those recipient s without CMV pneumonia (84.6 vs. 11.2%, P=0.0001), Univariate analysi s 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 t ransplantation (P=0.0027), bacteremia (P=0.0105), and advanced United Network of Organ Sharing status (P=0.023) mere associated with CMV pne umonia. Cytomegalovirus viremia was diagnosed in 11 of 18 patients wit h CMV pneumonia at a median of 11 days (range 1-66 days) before diagno sis of CMV pneumonia. In a multivariate analysis using a time-dependen t, 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=0.00 01), and abdominal reoperation (RR=4.4, 95% CI 1.4-13.1, P=0.0043) wer e found to be independent predictors of CMV pneumonia. The attributabl e mortality associated with CMV pneumonia within the first year after liver transplantation for the patients with CR;IV pneumonia was 67.4%. Intensified measures for prevention of CMV should be considered for p atients at high risk. of developing CMV pneumonia.