EFFECT OF CYTOMEGALOVIRUS-INFECTION STATUS ON FIRST-YEAR MORTALITY-RATES AMONG ORTHOTOPIC LIVER-TRANSPLANT RECIPIENTS

Background: To reduce the mortality rate associated with liver transpl antation, it is important to identify the risk factors for increased m ortality among liver transplant recipients. It has been suggested that cytomegalovirus (CMV) infection is one such risk factor, but no studi es have examined mortality rates associated with the CMV serologic sta tus of the donor and recipient by using multivariate techniques. Objec tive: To study the elect of CMV on 1-year mortality rates in orthotopi c liver transplant recipients. Design: Intention-to-treat analysis of a cohort. Patients: 146 liver transplant recipients who were enrolled in a multicenter, randomized, placebo-controlled, intervention trial. Setting: Four university-affiliated transplantation centers. Results: 1-year mortality rates for the four strata of donor and recipient CMV serologic status before transplantation were as follows: seronegative donor and recipient, 11%, seronegative donor and seropositive recipien t, 22%; seropositive donor and recipient, 30%; and seropositive donor and seronegative recipient, 44% (P = 0.0091). Multivariate analysis us ing a time-dependent Cox proportional hazards model showed that retran splantation (relative risk, 4.6 [95% CI, 1.9 to 10.7]; P < 0.001); tot al number of units of blood products administered during transplantati on (relative risk, 1.006 per unit [CI, 1.003 to 1.010]; P < 0.001); an d presence of CMV disease (relative risk, 3.9 [CI, 1.8 to 8.5]; P < 0. 001), invasive fungal disease (relative risk, 3.3 [CI, 1.5 to 7.1]; P = 0.0020), and bacteremia (relative risk, 2.5 [CI, 1.2 to 5.2]; P = 0. 0136) were independently associated with higher mortality rates. If po st-transplantation variables that were highly correlated with donor an d recipient CMV serologic status were restricted from the model, donor and recipient CMV serologic status was the only pretransplantation va riable independently associated with higher mortality rates (P = 0.002 ). Conclusion: Donor and recipient CMV serologic status is a significa nt pretransplantation determinant for death in liver transplant recipi ents.