ABSTRACT
Introduction
: Advanced liver disease or cirrhosis is associated with an increased risk of infections; however, the impact of high pretransplant MELD score on cytomegalovirus (CMV) viremia after liver transplantation is unknown.
Methods
: This single center, retrospective, cohort study evaluated CMV high-risk (CMV IgG D+/R-) liver transplant recipients who received valganciclovir prophylaxis for 3 months between 2009 and 2019. Patients were stratified by pretransplant MELD score of < 35 (low MELD) and ≥ 35 (high MELD). The primary outcome was 12-month CMV viremia and secondary outcomes included CMV resistance and tissue invasive disease, mortality, biopsy-proven acute rejection (BPAR), leukopenia, and thrombocytopenia. Multivariable Cox proportional-hazards modeling was used to assess the association of MELD score with the time to CMV viremia.
Results
: There were 162 and 79 patients in the low and high MELD groups, respectively. Pretransplant MELD score ≥ 35 was associated with an increased risk of CMV viremia (HR 1.73; CI 1.06 to 2.82, p = 0.03). CMV viremia occurred at 162 ± 61 days in the low MELD group and 139 ± 62 days in the high MELD group. While BPAR occurred early at 30 days (13-59) in the low MELD group and at 18 days (11-66) in the high MELD group (p = 0.56), BPAR was not associated with an increased risk of CMV viremia (HR 1.55 (0.93-2.60), p = 0.1).
Discussion
: MELD scores ≥ 35 were associated with an increased hazards of CMV viremia. In liver transplant recipients with MELD scores ≥ 35 who are CMV high-risk, additional CMV intervention may be warranted.
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