This suggests that the major source of primary CMV infections seen in these two series was the administration of blood products

This suggests that the major source of primary CMV infections seen in these two series was the administration of blood products. may be at increased risk for invasive viral disease and especially invasive primary CMV disease. pneumonia. Intravenous immunoglobulin and acyclovir were not used prophylactically. Ganciclovir was administered on a compassionate use basis for biopsy-proven invasive CMV disease beginning in August 1987 and throughout the remainder of the study (approved by the Human Rights Committee of Childrens Hospital of Pittsburgh). Viral infections Viral infections were diagnosed by either culture, serology or histopathology in combination with clinical observations. All donors were screened for CMV. Surveillance serologies for CMV, Herpes simplex virus (HSV) and Epstein-Barr virus (EBV), as well as viral cultures of buffy coat, throat and urine were obtained preoperatively when possible. Additional samples were obtained when clinically indicated. Viral cultures were performed as previously described (14). CMV serologies were initially performed by anticomplement immunofluorescence (18); more recently, CMV antibody was determined with a solid-phase immunofluorescence (19). Viral infections were considered invasive if the virus was demonstrated by either culture or histology in a tissue biopsy or bronchoalveolar lavage specimen. EBV-associated posttransplant lymphoproliferative disorders (PTLD) were diagnosed on the basis of histopathology and serology (20). Statistical analysis Observed proportions were compared with the Chi-square test or two-tailed Fishers Exact Test for small samples. Calculated means were compared by Students t-test. The hierarchical log linear model was used to examine the possible combined associations of OKT3 therapy, retransplantation and development of viral infection. This analysis was intended to generate models rather than to test a particular hypothesis (21) and was performed utilizing BMDP4F Software (BMDP Statistical Software, Inc. Los Angeles, CA). Results Viral infection Fifty-three viral infections occurred in 58% (38/65) of patients. CMV accounted for half (26/53) of these episodes. The remainder were caused by HSV (7), respiratory syncytial virus (RSV) (5), adenovirus (5), rotavirus (4), EBV (3), parainfluenzae (2) and enterovirus (1). The mortality rate in patients with viral infection was 26% (10/38) compared to 4% (1/27) in patients who did not develop viral infection (p = 0.017). Thirty invasive viral infections occurred in 42% (27/65) of patients between 9 and 117 d following liver transplantation (mean SRPKIN-1 42 d). CMV was responsible for 70% (21/30) of these episodes. The remainder were caused by adenovirus (4), EBV (3), enterovirus (1) and RSV (1). The most frequent sites of visceral involvement were the liver (51 %) and the lungs (30%). Mortality following invasive viral infection was 37% (10/27) compared with only 3% (1/38) for those who did not develop invasive infection (p 0.001). Nine deaths were directly due to complications of viral infection, including CMV pneumonia (3), CMV cerebritis (1), disseminated adenoviral hepatitis (3), RSV pneumonia (1) and combined enteroviral/polymicrobial sepsis (1). Another patient developed severe CMV pneumonia and SRPKIN-1 hepatitis resulting in a rejection episode that necessitated retransplantation. This patient subsequently died of complications of retransplantation. OKT3 was administered to 22 of the 65 patients in this study. The proportion of patients who developed viral infections following OKT3 therapy was greater than in those who did not receive OKT3 (73% vs. 51% p=0.08), while was the proportion of individuals who developed invasive viral disease following OKT3 (59% vs. 33% p=0.04). An increased mortality MCAM rate was observed in those individuals who received OKT3 compared with those who did not (27% vs. 9% p = 0.08). The case-fatality rate of individuals who developed invasive viral illness was related for individuals who received OKT3 and for those who did not (6/13 vs. 4/14, p=0.35). Thirteen individuals required retransplantation within 3 months of the primary liver transplant operation. SRPKIN-1 The proportion of these individuals who developed viral infections was greater than in the solitary transplant recipients (92% vs. 51% p= 0.016). Similarly, invasive viral disease appeared to be more common in the retransplanted group compared with the solitary transplant group (69% vs. 36% p =0.10). Mortality following retransplantation was 31% compared to 11% after a single transplant (p = 0.11). The rate of recurrence of viral illness and invasive viral.