Clinical impact and risk factors for cytomegalovirus infection in deceased donor liver transplantation without prophylaxis: Single center experience

Abstract

Background: The study aims to elucidate the relationship between cytomegalovirus (CMV) infection and graft survival, as well as to identify risk factors for CMV infection in deceased donor liver transplantation (DDLT) recipients without prophylaxis. Methods: A retrospective study was conducted on 465 DDLT recipients at Severance Hospital, South Korea, employing a nested case-control design to explore CMV infection risk factors. Results: All study population showed CMV antibody seropositivity and did not received CMV prophylaxis. CMV infection was observed in 38.6% of DDLT recipients within the first year. Patients with CMV infection showed reduced graft survival rates within 5 years after matched time points compared to those without infection (57.9% vs. 67.5%, p=0.039), which confirmed in multivariable analysis (hazard ratio 1.44, p=0.047). Risk factor analysis revealed that Child-Pugh class C, donor liver macrovesicular steatosis ≥20%, and elevated pretransplant neutrophil levels were independently associated with an increased risk of CMV infection. Conclusion: This study confirms that CMV infection post-DDLT is a significant predictor of reduced graft survival. Addressing risk factors of CMV infection through targeted interventions could potentially improve patient management and post-transplant outcomes after DDLT.