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LETTER
Cytomegalovirus and Death in Liver Transplantation
Nina Singh, MD, and
Timothy Gayowski, MD
1 September 1997 | Volume 127 Issue 5 | Page 412
TO THE EDITOR:
Falagas and colleagues [1] concluded that the cytomegalovirus (CMV) serologic status of liver transplant donors and recipients was a significant determinant of death in the recipients. Our experience differs substantially from theirs. In our program, 130 patients have undergone orthotopic liver transplantation under tacrolimus-based primary immunosuppression in the 1990s. Neither CMV infection nor disease were predictors of death in our patients [2], and no correlation between the CMV serostatus of recipients and donors and death was seen (Table 1).
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Table 1. 1-Year Mortality Rates in Liver Transplant Recipients, Stratified by Donor and Recipient Cytomegalovirus Serologic Status
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The major difference in mortality rates, as shown in the Table 1, might be explained by the fact that Falagas and colleagues' study was done in the late 1980s, before the introduction of tacrolimus and the routine availability of ganciclovir. Tacrolimus-based immunosuppression has been associated with slightly improved survival [3] and a lower incidence of CMV infection after liver transplantation [3, 4]. The introduction of ganciclovir has led to a marked decrease in CMV-associated mortality in transplant recipients. It should be noted. however, that Stratta and colleagues [5] also saw no correlation between CMV serologic status and patient survival in a study of 211 liver transplant recipients who underwent transplantation between 1985 and 1989.
We do agree with Falagas and coworkers that more effective prophylactic strategies for CMV-seronegative recipients of CMV-seropositive organs are needed; however, their conclusion on the policy of matching recipient and donor according to CMV serologic status may not be uniformly applicable elsewhere. We recommend that other institutions evaluate and publish their experience with mortality rates and CMV serologic status. It would be prudent to assess the validity of the authors' conclusion before their policy is adopted elsewhere.
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Author and Article Information
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Veterans Affairs Medical Center; Pittsburgh, PA 15240
1. Falagas MD, Snydman DR, Griffith J, Ruthazer R, Werner BG, et al. Effect of cytomegalovirus infection status on first-year mortality rates among orthotopic liver transplant recipients. Ann Intern Med. 1997; 126:275-9.
2. Gayowski T, Marino IR, Singh N, Doyle HR, Wagener MM, Fung JJ, et al. Risk factors associated with mortality and infectious morbidity after liver transplantation [Abstract]. Annual Meeting of the American Association of the Study of Liver Diseases. Chicago; 1996.
3. Randomized trial comparing tacrolimus (FK506) and cyclosporine in prevention of liver allograft rejection. European FK506 Multicenter Liver Study Group. Lancet. 1994; 344:423-8.
4. Singh N, Mieles L, Yu VL, Starzl TE. Decreased incidence of viral infections in liver transplant recipients: possible effects of FK506. Dig Dis Sci. 1994; 39:15-8.
5. Stratta RJ, Shaeffer MS, Markin RS, Wood RP, Langnas AN, et al. Cytomegalovirus infection and disease after liver transplantation: an overview. Dig Dis Sci. 1992; 37:673-88.
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