Cytomegalovirus reactivation in liver transplant recipients due to hepatitis C cirrhosis is associated with higher cardiovascular risk - an observational, retrospective study
Por:
Aguilera V, Di Maira T, Conde I, Fornés-Ferrer V, Vinaixa C, Pallarés C, Carvalho-Gomes A, Cubells A, García M, Rubín Á, Benlloch S, Gonzalez-Dieguez L, Molina JM, Puchades L, López-Labrador FX, Prieto M and Berenguer M
Publicada:
1 jun 2018
Categoría:
Transplantation
Resumen:
The association between cytomegalovirus (CMV) reactivation and cardiovascular risk has been reported in solid organ transplant populations; however, it has yet to be assessed in liver transplantation (LT). We aim to evaluate whether CMV reactivation is associated with cardiovascular events (CVE) in HCV-LT patients. LT patients (2010 and 2014) due to HCV cirrhosis were included. Clinically significant CMV (CS-CMV) was defined as viral load (VL) >5000copies/ml, need of therapy or CMV disease. Baseline variables and endpoint measures (CVE, survival, severe recurrent hepatitis C, de novo tumors, and diabetes) were collected. One hundred and forty patients were included. At LT, a history of AHT was present in 23%, diabetes 22%, tobacco use 45%, obesity 20%, and renal impairment (eGFR<60ml/min) in 26.5%. CS-CMV reactivation occurred in 25% of patients. Twenty-six patients (18.5%) developed a CVE. Cox regression analysis revealed two factors significantly associated with CVE: Pre-LT DM [HR=4.6 95% CI (1.6, 13), P=0.004] and CS-CMV [HR=4.7 95% CI (1.8, 12.5), P=0.002]. CS-CMV was not independently associated with the remaining endpoints except for survival (P=0.03). In our series, CS-CMV reactivation was associated with a greater risk of developing CVE, thus confirming data from other solid organ transplant populations and emphasizing the need for adequate CMV control.
Filiaciones:
Aguilera V:
Liver Transplantation and Hepatology Unit, Hospital Universitari i Politécnic La Fe, Valencia, Spain
CIBERehd, Instituto de Salud Carlos III, Valencia, Spain
Di Maira T:
Liver Transplantation and Hepatology Unit, Hospital Universitari i Politécnic La Fe, Valencia, Spain
Conde I:
Liver Transplantation and Hepatology Unit, Hospital Universitari i Politécnic La Fe, Valencia, Spain
Laboratorio de Hepatología y Trasplante Hepático, Instituto de Investigación La Fe, Valencia, Spain
Fornés-Ferrer V:
Biostatistics Unit, Instituto de Investigación La Fe, Valencia, Spain
Vinaixa C:
Liver Transplantation and Hepatology Unit, Hospital Universitari i Politécnic La Fe, Valencia, Spain
CIBERehd, Instituto de Salud Carlos III, Valencia, Spain
Pallarés C:
CIBERehd, Instituto de Salud Carlos III, Valencia, Spain
Laboratorio de Hepatología y Trasplante Hepático, Instituto de Investigación La Fe, Valencia, Spain
Carvalho-Gomes A:
CIBERehd, Instituto de Salud Carlos III, Valencia, Spain
Laboratorio de Hepatología y Trasplante Hepático, Instituto de Investigación La Fe, Valencia, Spain
Cubells A:
Laboratorio de Hepatología y Trasplante Hepático, Instituto de Investigación La Fe, Valencia, Spain
García M:
Liver Transplantation and Hepatology Unit, Hospital Universitari i Politécnic La Fe, Valencia, Spain
CIBERehd, Instituto de Salud Carlos III, Valencia, Spain
Rubín Á:
Liver Transplantation and Hepatology Unit, Hospital Universitari i Politécnic La Fe, Valencia, Spain
CIBERehd, Instituto de Salud Carlos III, Valencia, Spain
Benlloch S:
Liver Transplantation and Hepatology Unit, Hospital Universitari i Politécnic La Fe, Valencia, Spain
CIBERehd, Instituto de Salud Carlos III, Valencia, Spain
Gonzalez-Dieguez L:
Liver Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
Molina JM:
Microbiology Department, Hospital Universitari i Politécnic La Fe, Valencia, Spain
Puchades L:
Liver Transplantation and Hepatology Unit, Hospital Universitari i Politécnic La Fe, Valencia, Spain
:
Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
Centro de Investigación Biomédica en Epidemiología y Salud Pública (CIBER ESP), Instituto de Salud Carlos III, Madrid, Spain
Prieto M:
Liver Transplantation and Hepatology Unit, Hospital Universitari i Politécnic La Fe, Valencia, Spain
CIBERehd, Instituto de Salud Carlos III, Valencia, Spain
Berenguer M:
Liver Transplantation and Hepatology Unit, Hospital Universitari i Politécnic La Fe, Valencia, Spain
CIBERehd, Instituto de Salud Carlos III, Valencia, Spain
Department of Medicine, Universitat de Valencia, Valencia, Spain
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