The clinical impact of ganciclovir prophylaxis on the occurrence of bacteremia in orthotopic liver transplant recipients

Luisa Munoz-Price, Michelle Slifkin, Robin Ruthazer, Debra D. Poutsiaka, Susan Hadley, Richard Freeman, Richard Rohrer, Michael Angelis, Jeffrey Cooper, Ralph Fairchild, Laurie Barefoot, Judy Bloom, Susan Fitzmaurice, David R. Snydman

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Abstract

Background. Cytomegalovirus (CMV) infection or receipt of a CMV-seropositive donor liver has been shown to be an independent predictor of bacteremia in orthotopic liver transplant (OLT) recipients. However, prevention of CMV infection through use of intense CMV prophylaxis has not been examined to assess the impact on bacteremia in liver transplant recipients. Methods. We analyzed the impact of CMV prophylaxis on rates of bacteremia by examining 192 consecutive OLT recipients during a 2-year follow-up period. Results. There were 29 episodes of bacteremia. Univariate analysis of risk factors for bacteremia showed that invasive fungal disease, initial anti-lymphocyte immunosuppression, treatment for rejection, and use of solumedrol were significantly associated with increased risk. Receipt of ≥ 14 days of ganciclovir prophylaxis (hazard ratio [HR], 0.40; 95% CI [confidence interval], 0.18-0.87; P = .02), end-to-end biliary anastomosis, and receipt of <10 units of red blood cells (RBCs) were significantly associated with a decreased risk. Three-variable analysis controlling for end-to-end anastomosis and use of <10 units of RBCs, showed that use of ≥14 days of ganciclovir was still associated with a reduced risk of bacteremia (HR, 0.44; 95% CI, 0.20-0.98; P = .0437). Conclusions. Among factors associated with bacteremia, use of prophylactic ganciclovir is independently associated with a significant reduction of bacteremia in OLT recipients.

Original languageEnglish
Pages (from-to)1293-1299
Number of pages7
JournalClinical Infectious Diseases
Volume39
Issue number9
DOIs
StatePublished - Nov 1 2004
Externally publishedYes

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Ganciclovir
Bacteremia
Liver
Cytomegalovirus
Cytomegalovirus Infections
Erythrocytes
Methylprednisolone Hemisuccinate
Confidence Intervals
Transplant Recipients
Mycoses
Immunosuppression
Tissue Donors
Lymphocytes

ASJC Scopus subject areas

  • Immunology

Cite this

Munoz-Price, L., Slifkin, M., Ruthazer, R., Poutsiaka, D. D., Hadley, S., Freeman, R., ... Snydman, D. R. (2004). The clinical impact of ganciclovir prophylaxis on the occurrence of bacteremia in orthotopic liver transplant recipients. Clinical Infectious Diseases, 39(9), 1293-1299. https://doi.org/10.1086/425002

The clinical impact of ganciclovir prophylaxis on the occurrence of bacteremia in orthotopic liver transplant recipients. / Munoz-Price, Luisa; Slifkin, Michelle; Ruthazer, Robin; Poutsiaka, Debra D.; Hadley, Susan; Freeman, Richard; Rohrer, Richard; Angelis, Michael; Cooper, Jeffrey; Fairchild, Ralph; Barefoot, Laurie; Bloom, Judy; Fitzmaurice, Susan; Snydman, David R.

In: Clinical Infectious Diseases, Vol. 39, No. 9, 01.11.2004, p. 1293-1299.

Research output: Contribution to journalArticle

Munoz-Price, L, Slifkin, M, Ruthazer, R, Poutsiaka, DD, Hadley, S, Freeman, R, Rohrer, R, Angelis, M, Cooper, J, Fairchild, R, Barefoot, L, Bloom, J, Fitzmaurice, S & Snydman, DR 2004, 'The clinical impact of ganciclovir prophylaxis on the occurrence of bacteremia in orthotopic liver transplant recipients', Clinical Infectious Diseases, vol. 39, no. 9, pp. 1293-1299. https://doi.org/10.1086/425002
Munoz-Price, Luisa ; Slifkin, Michelle ; Ruthazer, Robin ; Poutsiaka, Debra D. ; Hadley, Susan ; Freeman, Richard ; Rohrer, Richard ; Angelis, Michael ; Cooper, Jeffrey ; Fairchild, Ralph ; Barefoot, Laurie ; Bloom, Judy ; Fitzmaurice, Susan ; Snydman, David R. / The clinical impact of ganciclovir prophylaxis on the occurrence of bacteremia in orthotopic liver transplant recipients. In: Clinical Infectious Diseases. 2004 ; Vol. 39, No. 9. pp. 1293-1299.
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abstract = "Background. Cytomegalovirus (CMV) infection or receipt of a CMV-seropositive donor liver has been shown to be an independent predictor of bacteremia in orthotopic liver transplant (OLT) recipients. However, prevention of CMV infection through use of intense CMV prophylaxis has not been examined to assess the impact on bacteremia in liver transplant recipients. Methods. We analyzed the impact of CMV prophylaxis on rates of bacteremia by examining 192 consecutive OLT recipients during a 2-year follow-up period. Results. There were 29 episodes of bacteremia. Univariate analysis of risk factors for bacteremia showed that invasive fungal disease, initial anti-lymphocyte immunosuppression, treatment for rejection, and use of solumedrol were significantly associated with increased risk. Receipt of ≥ 14 days of ganciclovir prophylaxis (hazard ratio [HR], 0.40; 95{\%} CI [confidence interval], 0.18-0.87; P = .02), end-to-end biliary anastomosis, and receipt of <10 units of red blood cells (RBCs) were significantly associated with a decreased risk. Three-variable analysis controlling for end-to-end anastomosis and use of <10 units of RBCs, showed that use of ≥14 days of ganciclovir was still associated with a reduced risk of bacteremia (HR, 0.44; 95{\%} CI, 0.20-0.98; P = .0437). Conclusions. Among factors associated with bacteremia, use of prophylactic ganciclovir is independently associated with a significant reduction of bacteremia in OLT recipients.",
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T1 - The clinical impact of ganciclovir prophylaxis on the occurrence of bacteremia in orthotopic liver transplant recipients

AU - Munoz-Price, Luisa

AU - Slifkin, Michelle

AU - Ruthazer, Robin

AU - Poutsiaka, Debra D.

AU - Hadley, Susan

AU - Freeman, Richard

AU - Rohrer, Richard

AU - Angelis, Michael

AU - Cooper, Jeffrey

AU - Fairchild, Ralph

AU - Barefoot, Laurie

AU - Bloom, Judy

AU - Fitzmaurice, Susan

AU - Snydman, David R.

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N2 - Background. Cytomegalovirus (CMV) infection or receipt of a CMV-seropositive donor liver has been shown to be an independent predictor of bacteremia in orthotopic liver transplant (OLT) recipients. However, prevention of CMV infection through use of intense CMV prophylaxis has not been examined to assess the impact on bacteremia in liver transplant recipients. Methods. We analyzed the impact of CMV prophylaxis on rates of bacteremia by examining 192 consecutive OLT recipients during a 2-year follow-up period. Results. There were 29 episodes of bacteremia. Univariate analysis of risk factors for bacteremia showed that invasive fungal disease, initial anti-lymphocyte immunosuppression, treatment for rejection, and use of solumedrol were significantly associated with increased risk. Receipt of ≥ 14 days of ganciclovir prophylaxis (hazard ratio [HR], 0.40; 95% CI [confidence interval], 0.18-0.87; P = .02), end-to-end biliary anastomosis, and receipt of <10 units of red blood cells (RBCs) were significantly associated with a decreased risk. Three-variable analysis controlling for end-to-end anastomosis and use of <10 units of RBCs, showed that use of ≥14 days of ganciclovir was still associated with a reduced risk of bacteremia (HR, 0.44; 95% CI, 0.20-0.98; P = .0437). Conclusions. Among factors associated with bacteremia, use of prophylactic ganciclovir is independently associated with a significant reduction of bacteremia in OLT recipients.

AB - Background. Cytomegalovirus (CMV) infection or receipt of a CMV-seropositive donor liver has been shown to be an independent predictor of bacteremia in orthotopic liver transplant (OLT) recipients. However, prevention of CMV infection through use of intense CMV prophylaxis has not been examined to assess the impact on bacteremia in liver transplant recipients. Methods. We analyzed the impact of CMV prophylaxis on rates of bacteremia by examining 192 consecutive OLT recipients during a 2-year follow-up period. Results. There were 29 episodes of bacteremia. Univariate analysis of risk factors for bacteremia showed that invasive fungal disease, initial anti-lymphocyte immunosuppression, treatment for rejection, and use of solumedrol were significantly associated with increased risk. Receipt of ≥ 14 days of ganciclovir prophylaxis (hazard ratio [HR], 0.40; 95% CI [confidence interval], 0.18-0.87; P = .02), end-to-end biliary anastomosis, and receipt of <10 units of red blood cells (RBCs) were significantly associated with a decreased risk. Three-variable analysis controlling for end-to-end anastomosis and use of <10 units of RBCs, showed that use of ≥14 days of ganciclovir was still associated with a reduced risk of bacteremia (HR, 0.44; 95% CI, 0.20-0.98; P = .0437). Conclusions. Among factors associated with bacteremia, use of prophylactic ganciclovir is independently associated with a significant reduction of bacteremia in OLT recipients.

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