Active cytomegalovirus (CMV) infection in liver recipients in a high CMV seroprevalence region - outcomes and the use of antigenemia

Abstract

Cytomegalovirus (CMV) is the most frequent viral infection in liver recipients, acting as immunomodulatory factor for other opportunistic infections and rejection. We assessed the outcomes of CMV infection in liver recipients in a high CMV seroprevalence region and the use of antigenemia for the diagnosis of CMV syndrome. Between March 2007 and April 2009, 44 liver recipients collected 344 samples for CMV antigenemia. Defi nition of active CMV infections used literature criteria. Recipients’ outcomes [CMV syndrome, Hepatitis C Virus (HCV) recurrence, rejection and mortality] were analyzed. Performance of antigenemia for the diagnosis of CMV syndrome was assessed by the area under the Receiver Operating Curve (AUROC) of 52 positive samples, representing 24 recipients. CMV serology was positive (R+) in 90.9% of liver recipients. CMV syndrome occurred in 18 (40.9%) recipients. CMV negative serology (R-) recipients had lower disease-free time, as well as lower one-year and four-year survival rates (p = 0.022 and p = 0.004, respectively). HCV+ recipients presented CMV-associated indirect eff ects and had a tendency to lower fouryear survival rate (p=0.089). Th e AUROC for CMV syndrome was 0.745 (95% CI 0.606 to 0.856, p = 0.006), with a cut-off of more than 8 positive cells/200,000 leukocytes, (sensitivity of 88.9% and specifi city of 74.4%). CMV infection is associated to morbidity and lower survival rates in liver recipients in a high CMV seroprevalence region. Using antigenemia, the cut-off for diagnosing CMV syndrome was higher than 8 positive cells/200,000 leukocytes, with an appropriated performance through its accuracy.