Abstension from treatment of low-level pp65 cytomegalovirus antigenemia after liver transplantation: A prospective study

Background Ganciclovir is a highly effective and relatively safe drug to tr eat cytomegalovirus (CMV) infection in liver transplant patients; CMV resis tance to ganciclovir is progressively emerging due to the extensive use of the drug in transplant and AIDS patients; CMV pp65 antigenemia allows early diagnosis of CMV infection and quantitation of the viral load; preemptive antigenemia-guided therapy of CMV infection can prevent CMV disease but the threshold of antigenemia value above which treatment has to be instituted is unclear. Methods, To demonstrate the safety of abstention from preemptive treatment in the presence of low levels of antigenemia 77 consecutive liver transplan t recipients were prospectively evaluated. Antigenemia was tested twice a w eek from transplantation until discharge, then once a week until the third postoperative month. In absence of risk factors for CMV disease, namely don or positive/recipient negative CMV serology, treatment with antibodies to l ymphocytes and retransplantation, only patients with antigenemia of more th an 50 or symptoms possibly related to CMV infection had preemptive treatmen t. Results. A total of 32 patients had at least one positive antigenemia test with a value less than 50; 22 (68.7%) spontaneously cleared the virus, 3 we re treated with i.v, ganciclovir for the presence of fever, and the other 7 (21,8%) progressed to values of antigenemia of more than 50 and were treat ed even if asymptomatic. No CMV disease was observed in these patients. Conclusion. CMV antigenemia less than 50 in Liver transplant recipients wit h low and intermediate risk for CMV disease does not mandate preemptive gan ciclovir treatment. Close surveillance with repeated determination of antig enemia until its negativization and careful clinical and laboratory monitor ing is advisable.