Prophylactic anti-cytomegalovirus hyperimmunoglobulin in critically ill liver transplant patients: impact on early immunology and survival

GND
131626817
ORCID
http://orcid.org/0000-0002-3438-8969
Zugehörigkeit
School of Medicine, Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany, ArnoKornberg@aol.com
Kornberg, Arno;
Zugehörigkeit
School of Medicine, Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany, Ulrike.Witt@tum.de
Witt, Ulrike;
Zugehörigkeit
Department of Anaesthesiology, Klinikum Großhadern, Ludwig-Maximilian-University of Munich, Munich 81377, Germany, JenniferKornberg@aol.com
Kornberg, Jennifer;
Zugehörigkeit
Department of Surgery, Friedrich-Schiller-University of Jena, Jena 07747, Germany, katharina.mueller86@gmx.de
Müller, Katharina;
GND
142541028
Zugehörigkeit
School of Medicine, Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany, Helmut.Friess@tum.de
Friess, Helmut;
GND
130036293
Zugehörigkeit
Institute of Pathology, Helios Klinikum Berlin, Berlin 14165, Germany, katharina.thrum@gmail.com
Thrum, Katharina

Background: Anti-cytomegalovirus hyperimmunoglobulin (CMVIg) was shown to provide beneficial immunodulatory properties beyond antiviral efficacies. The aim of this retrospective study was to assess the impact of prophylactic CMVIg treatment on early outcome following liver transplantation (LT) in critically ill patients. Methods: Forty-three cirrhotic patients requiring pre-LT intensive care due to multiorgan failure were analyzed. Twenty-eight patients with enhanced CMV risk (D+/R+; D+/R−; D−/R+) received prophylactic CMVIg for a minimum of 7 days, while 15 patients (D−/R−) did not. Results: Post-transplantation rates of intra-abdominal infections (28% vs. 61.1%; p = 0.03), Epstein–Barr virus infections (0% vs. 33.3%; p = 0.034), allograft rejections (0% vs. 22.2%; p = 0.013) and sepsis-related mortality (4% vs. 27.8%; p = 0.026) were significantly lower, whereas incidence of CMV infections (4% vs. 22.2%; p = 0.066) tended to be lower in the CMVIg subset. In multivariate analysis, only pretransplant elevated serum lactate level (hazard ratio = 34.63; p = 0.009) and absence of CMVIg therapy (hazard ratio = 21.76; p = 0.023) were identified as independent promoters of 3-month mortality. Conclusion: Prophylactic treatment with CMVIg reduces predisposition for severe immunological and septic events and, thereby, early mortality in critically ill liver recipients.

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