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• W4296475255 abstract "<h3></h3> Cytomegalovirus (CMV) infection or reactivation is common after transplantation. Among liver transplant recipients viraemia is associated with morbidity and adverse outcomes. It is unclear as to whether prophylaxis or pre-emptive treatment is preferable in those at risk, although recent work has supported the latter. Our centre provides valganciclovir prophylaxis for 100 days to CMV seronegative patients receiving a seropositive graft (mismatch). We conducted a retrospective chart review from 2018–07-01 to 2021–09-05 at a single centre. Patients who died during their index inpatient stay or patients undergoing repeat or multi-organ transplantation were excluded. Protocol mandated that inpatients underwent weekly CMV-PCR testing and at each outpatient appointment after discharge. 300 consecutive patients were reviewed and 16 were excluded with 284 included. Of whom, 180 (63%) were men and median age was 57 (IQR 49–63) years. Major indications for transplant were NASH (20%), alcohol (20%), and PSC (10%). Patients were followed for a median 597 (278–1096) days. CMV donor(d)/recipient(r) status was as follows: d+r+ 61 (21%); d+r- ”mismatch” 72 (25%); d-r+ 67 (24%); d-r- 84 (30%). Aetiologies, ages, and sexes were similar between groups. Valganciclovir prophylaxis was given to 100% of d+r- patients (for 100–120 days) and 5 (8%) d+r+ patients outside protocol. CMV viraemia occurred in 79 (28%) of 284 patients. The cumulative incidence of CMV was d+r+ 43%; 64% d+r-; d-r+ 20%; d-r- 0%; p<0.001. The median time to viraemia was d+r+ 36 (30–120), d+r- 151 (123–163), and d-r+ 30 (27–42) days; p<0.001. Viraemia did not occur during valganciclovir prophylaxis. Among 79 developing viraemia, treatment was required in 19 (76%) d+r+; 36 (86%) d+r-; 8 (67%) d-r+; p=0.266. Data on hospital re-admission was available in 67, 5 of whom were already inpatients. Of the 62 remaining, readmission was required in: d+r+ 40%; d+r- 35%; d-r+ 20%; p=0.603. Viral load at diagnosis was similar between groups. Relapse requiring further treatment occurred in 8 (10%) of 79. Mycophenolate use (vs azathioprine use) was not associated with post-transplant viraemia (61% v 55%; p=0.636). This study highlights relative risks of CMV viraemia in relation to donor/recipient serology in a contemporary cohort. We show that prophylaxis is highly effective in delaying – but not preventing – CMV viraemia, which occurs in the majority of mismatch patients. CMV viraemia is also frequent in other patient sub-groups with treatment being required a similar proportion of d+r+ to d+r- patients." @default.
• W4296475255 created "2022-09-21" @default.
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• W4296475255 date "2022-09-01" @default.
• W4296475255 modified "2023-09-27" @default.
• W4296475255 title "P74 CMV viraemia after liver transplantation is frequent but delayed by prophylaxis" @default.
• W4296475255 doi "https://doi.org/10.1136/gutjnl-2022-basl.125" @default.
• W4296475255 hasPublicationYear "2022" @default.
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