Prophylactic Anti-Cytomegalovirus Hyperimmunoglobulin in Critically Ill Liver Transplant Patients: Impact on Early Immunology and Survival.

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%; = 0.03), Epstein-Barr virus infections (0% vs. 33.3%; = 0.034), allograft rejections (0% vs. 22.2%; = 0.013) and sepsis-related mortality (4% vs. 27.8%; = 0.026) were significantly lower, whereas incidence of CMV infections (4% vs. 22.2%; = 0.066) tended to be lower in the CMVIg subset. In multivariate analysis, only pretransplant elevated serum lactate level (hazard ratio = 34.63; = 0.009) and absence of CMVIg therapy (hazard ratio = 21.76; = 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.