CLINICAL AND EPIDEMIOLOGIC PREDICTORS OF RECURRENT CYTOMEGALOVIRUS DISEASE IN ORTHOTOPIC LIVER-TRANSPLANT RECIPIENTS

Predictors of recurrent cytomegalovirus (CMV) disease after the first episode of successfully treated CMV disease in orthotopic liver transp lant recipients were studied. Recurrent CMV disease was defined as dis ease diagnosed >14 days after the end of a minimum 8-day course of gan ciclovir therapy for the first episode and was classified as early or late if it occurred within or after 90 days, respectively, after compl etion of ganciclovir treatment, Eleven (27%) of 41 patients had recurr ent CMV disease (nine early recurrences and two late recurrences). Dea th was more likely to occur in patients with recurrent CMV disease tha n in those without it (55% vs. 13%, respectively; P = .006). Initial e pisodes of multiorgan CMV disease (P = .001) and CMV pneumonia (P = .0 12) were associated with early recurrence, Multivariate analysis showe d that multiorgan CMV disease was independently associated with early recurrence (P = .003; odds ratio, 13.5; 95% confidence interval, 2.4-7 6.8), Recognition of risk factors for recurrent CMV disease may help i dentify patients for whom a more intensive therapeutic or diagnostic a pproach is needed.