Comparison of prophylaxis and preemptive strategy as cytomegalovirus prevention in liver transplant recipients

Objectives Prophylaxis (P) or pre‐emptive strategy (PS) in high‐risk liver transplant recipients (LTRs) are either recommended. We compared the results of each strategy. Methods Two groups of LTR transplanted during two consecutive periods were compared. Only cytomegalovirus (CMV)‐mismatched LTR (Donor +/ Recipient ‐) were included. The primary endpoints were: the onset of polymerase chain reaction‐based DNAemia and the proportion of patients with CMV disease. A number of episodes of CMV infection, antiviral therapy, ganciclovir resistance, infectious or immunological complications, cost of both strategies, and survival (1, 5, and 10 years) were also compared. Results Forty‐eight and 60 patients were respectively included in the P and PS groups. Eighteen (38%) in the P group and 56 (93%) in the PS group had CMV DNAemia ( p <.0001) with a similar CMV disease rate (16.7% and 15%). Duration of curative therapy was longer in the PS group: 91 days versus 16 ( p <.0001). Acute rejection was less frequent ( p = .04) and more patients experienced a ganciclovir‐resistant CMV infection in the PS group (10% vs. 0, p = .03). The drug‐associated cost of PS was higher (10 004 vs. 4804€) and the median number of rehospitalization days tended to be higher (6 vs. 4, p = .06). Survival at any time was similar. Conclusion We reported more CMV DNAemias and ganciclovir‐resistant CMV events with PS. The cost of the PS strategy was higher.