Preemptive Therapy in CMV-Antigen Positive Patients after LiverTransplantation - a Prospective-Trial

Objective: Preemptive therapy with intravenous gannciclovir and CMV-hyperimmunoglobulin in asymptomatic CMV pp65-antigen positive patients was compared with treatment of only symptomatic CMV-disease after liver transplantation in an open prospective study. Patients and methods: 48 out of 200 liver transplant recipients became positive during six weeks follow-up after transplantation. 17out of these 48 patients who were already symptomatic at the time of positive antigen testing were successfully treated with ganciclovir and CMV-hyperimmunoglobulin. 31 asymptomatic antigen-positive pa.tients were randomised to receive preemptive therapy or to receive therapy only at onset of clinical symptoms. Results: Only two out of 15 patients in this latter grouup without preemptive therapy developed CMV-syndrome and were successfully treated with intravenous ganciclovir. 13 patients did not experience any clinicalsymptoms or disease and were therefore spared unneccessary toxicity and costs. The overall incidence of CMV-infection and -disease in the whole study population of 200 liver transplant recipients was 25% and 10%. As expected, CMV-negative patients who f2ceived an organ from a seropositive donor were at a higher risk of CMV-infection and -disease, but did not show more severe infections clinically. Patients with IL-2 receptor antibody induction therapy seemed to have a higher risk for CMV-infection and -disease.

Keywords: Liver Transplantation, CMV-infection, Preemptive Therapy