Primary sclerosing cholangitis as an independent risk factor for cytomegalovirus infection after liver transplant

Background: Cytomegalovirus (CMV) infection is one of the most common infectious complications after solid organ transplant; it is associated with morbidity and mortality and with many direct and indirect effects. However, monitoring and therapeutic procedures are very heterogeneous across treatment centers. Additionally, factors that place patients at risk of CMV infection are poorly defined.

Methods: Clinical and demographic data from 833 LT recipients and their donors were retrospectively analyzed. Univariate and multivariate analysis were applied. CMV infection was detected by quantitative nucleic acid testing with a lower limit of detection of 40 IU/mL.

Results: In total, 192 of 833 patients (23%) experienced at least one episode of CMV infection after LT; CMV infection occurred to a large extent during the first year after transplant (70%). Multivariate analysis demonstrated that CMV donor-recipient risk constellation (OR 2.05, 95% CI) and primary sclerosing cholangitis (PSC) before LT (OR 3.76, 95% CI) are independent risk factors for CMV infection after LT.

Conclusion: Patients with high-risk serostatus, PSC, or both should be monitored more thoroughly and should receive prolonged prophylaxis against CMV infection.