Cytomegalovirus Disease as a Risk Factor for Invasive Fungal Infections in Liver Transplant Recipients under Targeted Antiviral and Antimycotic Prophylaxis
Cytomegalovirus (CMV) infection is the most common opportunistic infection that occurs following orthotopic liver transplantation (OLT). In addition to the direct infection-related symptoms, it also triggers an immunological response that may contribute to adverse clinical outcomes. CMV disease has...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-08-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/12/16/5198 |
| _version_ | 1797584326389399552 |
|---|---|
| author | Robert Breitkopf Benedikt Treml Zoran Bukumiric Nicole Innerhofer Margot Fodor Aleksandra Radovanovic Spurnic Sasa Rajsic |
| author_facet | Robert Breitkopf Benedikt Treml Zoran Bukumiric Nicole Innerhofer Margot Fodor Aleksandra Radovanovic Spurnic Sasa Rajsic |
| author_sort | Robert Breitkopf |
| collection | DOAJ |
| description | Cytomegalovirus (CMV) infection is the most common opportunistic infection that occurs following orthotopic liver transplantation (OLT). In addition to the direct infection-related symptoms, it also triggers an immunological response that may contribute to adverse clinical outcomes. CMV disease has been described as a predictor of invasive fungal infections (IFIs) but its role under an antiviral prophylaxis regimen is unclear. Methods: We retrospectively analyzed the medical records of 214 adult liver transplant recipients (LTRs). Universal antiviral prophylaxis was utilized in recipients with CMV mismatch; intermediate- and low-risk patients received pre-emptive treatment. Results: Six percent of patients developed CMV disease independent of their serostatus. The occurrence of CMV disease was associated with elevated virus load and increased incidence of leucopenia and IFIs. Furthermore, CMV disease was associated with higher one-year mortality and increased relapse rates within the first year of OLT. Conclusions: CMV disease causes significant morbidity and mortality in LTRs, directly affecting transplant outcomes. Due to the increased risk of IFIs, antifungal prophylaxis for CMV disease may be appropriate. Postoperative CMV monitoring should be considered after massive transfusion, even in low-risk serostatus constellations. In case of biliary complications, biliary CMV monitoring may be appropriate in the case of CMV-DNA blood-negative patients. |
| first_indexed | 2024-03-10T23:50:16Z |
| format | Article |
| id | doaj.art-3e8a18ff1a6e48f19005aee55c93115f |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T23:50:16Z |
| publishDate | 2023-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-3e8a18ff1a6e48f19005aee55c93115f2023-11-19T01:39:22ZengMDPI AGJournal of Clinical Medicine2077-03832023-08-011216519810.3390/jcm12165198Cytomegalovirus Disease as a Risk Factor for Invasive Fungal Infections in Liver Transplant Recipients under Targeted Antiviral and Antimycotic ProphylaxisRobert Breitkopf0Benedikt Treml1Zoran Bukumiric2Nicole Innerhofer3Margot Fodor4Aleksandra Radovanovic Spurnic5Sasa Rajsic6Department of Anesthesia and Intensive Care Medicine, Medical University Innsbruck, 6020 Innsbruck, AustriaDepartment of Anesthesia and Intensive Care Medicine, Medical University Innsbruck, 6020 Innsbruck, AustriaInstitute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, SerbiaDepartment of Anesthesia and Intensive Care Medicine, Medical University Innsbruck, 6020 Innsbruck, AustriaDepartment of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, AustriaClinic for Infectious and Tropical Diseases, University Clinical Centre of Serbia, 11000 Belgrade, SerbiaDepartment of Anesthesia and Intensive Care Medicine, Medical University Innsbruck, 6020 Innsbruck, AustriaCytomegalovirus (CMV) infection is the most common opportunistic infection that occurs following orthotopic liver transplantation (OLT). In addition to the direct infection-related symptoms, it also triggers an immunological response that may contribute to adverse clinical outcomes. CMV disease has been described as a predictor of invasive fungal infections (IFIs) but its role under an antiviral prophylaxis regimen is unclear. Methods: We retrospectively analyzed the medical records of 214 adult liver transplant recipients (LTRs). Universal antiviral prophylaxis was utilized in recipients with CMV mismatch; intermediate- and low-risk patients received pre-emptive treatment. Results: Six percent of patients developed CMV disease independent of their serostatus. The occurrence of CMV disease was associated with elevated virus load and increased incidence of leucopenia and IFIs. Furthermore, CMV disease was associated with higher one-year mortality and increased relapse rates within the first year of OLT. Conclusions: CMV disease causes significant morbidity and mortality in LTRs, directly affecting transplant outcomes. Due to the increased risk of IFIs, antifungal prophylaxis for CMV disease may be appropriate. Postoperative CMV monitoring should be considered after massive transfusion, even in low-risk serostatus constellations. In case of biliary complications, biliary CMV monitoring may be appropriate in the case of CMV-DNA blood-negative patients.https://www.mdpi.com/2077-0383/12/16/5198cytomegalovirusinvasive fungal infectionsliver transplantationserostatusvirus load |
| spellingShingle | Robert Breitkopf Benedikt Treml Zoran Bukumiric Nicole Innerhofer Margot Fodor Aleksandra Radovanovic Spurnic Sasa Rajsic Cytomegalovirus Disease as a Risk Factor for Invasive Fungal Infections in Liver Transplant Recipients under Targeted Antiviral and Antimycotic Prophylaxis Journal of Clinical Medicine cytomegalovirus invasive fungal infections liver transplantation serostatus virus load |
| title | Cytomegalovirus Disease as a Risk Factor for Invasive Fungal Infections in Liver Transplant Recipients under Targeted Antiviral and Antimycotic Prophylaxis |
| title_full | Cytomegalovirus Disease as a Risk Factor for Invasive Fungal Infections in Liver Transplant Recipients under Targeted Antiviral and Antimycotic Prophylaxis |
| title_fullStr | Cytomegalovirus Disease as a Risk Factor for Invasive Fungal Infections in Liver Transplant Recipients under Targeted Antiviral and Antimycotic Prophylaxis |
| title_full_unstemmed | Cytomegalovirus Disease as a Risk Factor for Invasive Fungal Infections in Liver Transplant Recipients under Targeted Antiviral and Antimycotic Prophylaxis |
| title_short | Cytomegalovirus Disease as a Risk Factor for Invasive Fungal Infections in Liver Transplant Recipients under Targeted Antiviral and Antimycotic Prophylaxis |
| title_sort | cytomegalovirus disease as a risk factor for invasive fungal infections in liver transplant recipients under targeted antiviral and antimycotic prophylaxis |
| topic | cytomegalovirus invasive fungal infections liver transplantation serostatus virus load |
| url | https://www.mdpi.com/2077-0383/12/16/5198 |
| work_keys_str_mv | AT robertbreitkopf cytomegalovirusdiseaseasariskfactorforinvasivefungalinfectionsinlivertransplantrecipientsundertargetedantiviralandantimycoticprophylaxis AT benedikttreml cytomegalovirusdiseaseasariskfactorforinvasivefungalinfectionsinlivertransplantrecipientsundertargetedantiviralandantimycoticprophylaxis AT zoranbukumiric cytomegalovirusdiseaseasariskfactorforinvasivefungalinfectionsinlivertransplantrecipientsundertargetedantiviralandantimycoticprophylaxis AT nicoleinnerhofer cytomegalovirusdiseaseasariskfactorforinvasivefungalinfectionsinlivertransplantrecipientsundertargetedantiviralandantimycoticprophylaxis AT margotfodor cytomegalovirusdiseaseasariskfactorforinvasivefungalinfectionsinlivertransplantrecipientsundertargetedantiviralandantimycoticprophylaxis AT aleksandraradovanovicspurnic cytomegalovirusdiseaseasariskfactorforinvasivefungalinfectionsinlivertransplantrecipientsundertargetedantiviralandantimycoticprophylaxis AT sasarajsic cytomegalovirusdiseaseasariskfactorforinvasivefungalinfectionsinlivertransplantrecipientsundertargetedantiviralandantimycoticprophylaxis |