The effect of different immunoprophylaxis regimens on post‐transplant cytomegalovirus (CMV) infection in CMV‐seropositive liver transplant recipients

Background The effects of different immunoprophylaxis regimens on cytomegalovirus (CMV) infection in liver transplant recipients (LTRs) have not been compared. Methods In a cohort, we studied 343 CMV‐seropositive recipient (R+) and 83 seronegative donor/recipient (D−/R−) consecutive LTRs from 2004 to 2007. Immunoprophylaxis regimens included steroid‐only, steroids plus rabbit anti‐thymocyte globulin (rATG), and steroids plus basiliximab. Logistic regression analysis, Cox proportional hazards regression model, and log‐rank test were performed for multivariate analysis as appropriate. Results In total, 164 (39%), 69 (16%), and 193 (45%) patients received steroid‐only, basiliximab, and rATG immunoprophylaxis, respectively. CMV infection rates were 15.7% (54/343) in CMV R+ LTRs and 2.4% (2/83) in CMV R− LTRs. Among CMV R+ LTRs who received rATG, the use of at least 6 weeks of CMV prophylaxis reduced the rate of CMV infection from 24.4% (19/78) to 11.7% (9/77). In multivariate analysis, CMV R+ vs D−/R− (odds ratio [OR]=13.1, 95% confidence interval [CI]: 1.8‐97.2), rATG >3 mg/kg vs steroid‐only induction (OR=1.6, 95% CI: 1.1‐2.3), and CMV prophylaxis