RISK-FACTORS FOR CYTOMEGALOVIRUS AND SEVERE BACTERIAL-INFECTIONS FOLLOWING LIVER-TRANSPLANTATION - A PROSPECTIVE MULTIVARIATE TIME-DEPENDENT ANALYSIS

Risk factors for cytomegalovirus and severe bacterial infections were studied prospectively by univariate, multivariate and time-dependent C ox model analysis in 79 consecutive liver transplant patients treated with selective bowel decontamination. Cytomegalovirus infection occurr ed in 39 patients (49%) and was symptomatic in 22 patients. Twenty-six patients (33%) developed at least one of 43 documented severe bacteri al infections. In a multivariate analysis of risk factors for all cyto megalovirus infections, the cytomegalovirus seronegative recipient-cyt omegalovirus seropositive donor group was the highest risk group (P < 0.001). Using the same analysis for risk factors for symptomatic cytom egalovirvs infections, a prolonged prothrombin time (P < 0.005), a dia gnosis of acute fulminant hepatitis as the underlying liver disease (P < 0.01) and a cytomegalovirus seronegative patient receiving a liver from a seropositive donor (P < 0.001) were significant. The treatment with OKT3 therapy (P < 0.008) and hepatic artery thrombosis (P < 0.02) were found to be significant risk factors in a time-dependent univari ate analysis but were not independent risk factors when multivariate a nalysis was utilized. Significant risk factors for major bacterial inf ections (P < 0.03) using univariate analysis included a prolonged anes thesia, anhepatic and surgical times, as well as the transfusion of la rge amounts of fresh frozen plasma or autologous blood. In a multivari ate analysis, only the transfusion of large amounts of fresh frozen pl asma (P < 0.04) was a significant independent risk factor. Cytomegalov irus infection was a risk factor for the development of severe bacteri al infections (P < 0.03) in a multivariate time-dependent analysis.