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Cytomegalovirus and Death in Liver Transplantation
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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TO THE EDITOR:
Falagas and colleagues [1] concluded that the cytomegalovirus (CMV) serologic status of liver transplant donors and recipients was a significant determinant of death in the recipients. Our experience differs substantially from theirs. In our program, 130 patients have undergone orthotopic liver transplantation under tacrolimus-based primary immunosuppression in the 1990s. Neither CMV infection nor disease were predictors of death in our patients [2], and no correlation between the CMV serostatus of recipients and donors and death was seen (Table 1).
The major difference in mortality rates, as shown in the Table 1, might be explained by the fact that Falagas and colleagues' study was done in the late 1980s, before the introduction of tacrolimus and the routine availability of ganciclovir. Tacrolimus-based immunosuppression has been associated with slightly improved survival [3] and a lower incidence of CMV infection after liver transplantation [3, 4]. The introduction of ganciclovir has led to a marked decrease in CMV-associated mortality in transplant recipients. It should be noted. however, that Stratta and colleagues [5] also saw no correlation between CMV serologic status and patient survival in a study of 211 liver transplant recipients who underwent transplantation between 1985 and 1989.
We do agree with Falagas and coworkers that more effective prophylactic strategies for CMV-seronegative recipients of CMV-seropositive organs are needed; however, their conclusion on the policy of matching recipient and donor according to CMV serologic status may not be uniformly applicable elsewhere. We recommend that other institutions evaluate and publish their experience with mortality rates and CMV serologic status. It would be prudent to assess the validity of the authors' conclusion before their policy is adopted elsewhere.
Nina Singh, MD
Timothy Gayowski, MD
Veterans Affairs Medical Center; Pittsburgh, PA 15240
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
