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lüll Delayed-onset primary cytomegalovirus disease after liver transplantation Arthurs SK; Eid AJ; Pedersen RA; Dierkhising RA; Kremers WK; Patel R; Razonable RRLiver Transpl 2007[Dec]; 13 (12): 1703-9Clinical practice guidelines recommend antiviral prophylaxis to cytomegalovirus (CMV) donor-positive/recipient-negative (D+/R-) liver transplant recipients. We assessed the outcome of this strategy by determining the incidence, clinical features, and risk factors of CMV disease among CMV D+/R- liver transplant recipients who received antiviral prophylaxis. Sixty-seven CMV D+/R- liver transplant recipients (mean age+/-standard deviation: 49.5+/-11.4 years; 75% male) received oral ganciclovir [n=9 (13%)] or valganciclovir [n=58 (87%)] prophylaxis for a median duration of 92 days (interquartile range: 91-100). No breakthrough CMV disease was observed during antiviral prophylaxis. However, primary CMV disease was observed in 2%, 25%, 27%, 27%, and 29% of patients at 1, 3, 6, 12, and 24 months, respectively, after antiviral prophylaxis was stopped. The incidence of delayed-onset primary CMV disease was similar between those who received oral ganciclovir and valganciclovir. Nine (47%) patients had CMV syndrome, 8 (42%) had gastrointestinal CMV disease, and 2 (11%) had CMV hepatitis. Female patients (P=0.01) and younger age at transplant (P=0.03) were associated with an increased risk, whereas diabetes mellitus (P<0.001) was significantly associated with a lower risk of delayed-onset primary CMV disease. Allograft loss or mortality occurred in 8 (12%) patients during the median follow-up period of 3.31 (range: 0.8-5.9) years. No significant association was observed between CMV disease and patient and allograft survival. In conclusion, CMV disease remains a common complication in CMV D+/R- liver transplant patients during the contemporary era of antiviral prophylaxis. Female patients and younger patients are at increased risk of delayed-onset primary CMV disease.|Administration, Oral[MESH]|Adult[MESH]|Age Factors[MESH]|Antiviral Agents/administration & dosage/*therapeutic use[MESH]|Cytomegalovirus Infections/etiology/mortality/*prevention & control[MESH]|Cytomegalovirus/*isolation & purification[MESH]|Drug Administration Schedule[MESH]|Female[MESH]|Follow-Up Studies[MESH]|Ganciclovir/administration & dosage/*analogs & derivatives/therapeutic use[MESH]|Graft Survival[MESH]|Humans[MESH]|Immunosuppressive Agents/adverse effects[MESH]|Incidence[MESH]|Liver Transplantation/*adverse effects/mortality[MESH]|Liver/surgery/*virology[MESH]|Male[MESH]|Middle Aged[MESH]|Proportional Hazards Models[MESH]|Retrospective Studies[MESH]|Risk Assessment[MESH]|Risk Factors[MESH]|Sex Factors[MESH]|Time Factors[MESH]|Valganciclovir[MESH] |