Cv. Paya et al., RISK-FACTORS FOR CYTOMEGALOVIRUS AND SEVERE BACTERIAL-INFECTIONS FOLLOWING LIVER-TRANSPLANTATION - A PROSPECTIVE MULTIVARIATE TIME-DEPENDENT ANALYSIS, Journal of hepatology, 18(2), 1993, pp. 185-195
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.