Cytomegalovirus Disease After Liver Transplantation: A Nationwide Population-Based Study P.-Y. Liu, S.-B. Cheng, C.-C. Lin, C.-H. Lin, S.-N. Chang, C.-Y. Cheng, Z.-Y. Shi, K.-C. Tung, and M.-J. Wu ABSTRACT Background. Cytomegalovirus (CMV) disease is a significant complication after liver transplantation. The estimated incidence varies among studies, which have been conducted in single regional centers and with small cohorts. In this study, we investigated the occurrence of CMV disease among liver transplant recipients in a national cohort in Taiwan. Methods. This retrospective study used data from the Taiwan National Health Insurance Research Database. All liver transplant recipients in the catastrophic illness database from 2000 to 2009 were enrolled. Cases of CMV disease were identified from the admission database with the use of the ICD-9-CM code 078. Results. The national cohort consisted of 1,721 liver transplant recipients (1,200 men and 521 women) with a mean age of 43.9  8.9 years at the time of transplantation. The mean follow-up duration was 3.6  2.7 years. The mortality rate was 14.9% at 1 year and 20.5% at 5 years. During the study period, 84 patients (4.9%) were diagnosed with CMV disease. The overall prevalence of CMV disease was 14.5 per 100 person-years. The cumulative incidences of post-transplantation CMV infection at 3 months, 6 months, 1 year, 2 years, 5 years, and 10 years were 1.2%, 2.7%, 3.8%, 4.2%, 4.8%, and 4.9%, respectively. The most common CMV-related diseases were colitis, hepatitis, and pneumonia. Conclusions. The risk of CMV disease was significantly elevated in the first 6 months after liver transplantation in the Taiwanese cohort.

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YTOMEGALOVIRUS (CMV) disease is one of the most common infectious complications among liver transplant recipients. An increase in the number of episodes of CMV disease heightens the risk of graft loss and death in liver transplant recipients [1]. The estimated incidence of CMV disease after liver transplantation is reported to be 18%e29% [2,3]. However, most studies were either conducted in a single regional center or had small case numbers. To our knowledge, data from large sample sizes regarding the incidence and risk of CMV disease among Asian liver transplant recipients is still scant. Thus, we conducted this large population-based study to investigate the occurrence of CMV disease after liver transplantation during a 10-year follow-up period in Taiwan. MATERIALS AND METHODS We used the Taiwan National Health Insurance Research Database (NHIRD) in this study. The Taiwan National Health Insurance is a 0041-1345/14/$esee front matter http://dx.doi.org/10.1016/j.transproceed.2013.12.009 832

universal health insurance program that was implemented in March 1995 in Taiwan. The National Health Research Institutes transfer From the Division of Infection (P.-Y.L., Z.-Y.S.), Liver Transplantation Center, Department of Surgery (S.-B.C.), Department of Pediatrics (C.-C.L.), Department of Medical Research (C.-H.L., S.-N.C.), Department of Pharmacy (C.-Y.C.), and Division of Nephrology (M.-J.W.), Taichung Veterans General Hospital; College of Veterinary Medicine, National Chung Hsing University (P.-Y.L., K.-C.T.); Department of Pharmacy, Tajen University (P.-Y.L.); School of Medicine, Chung Shan Medical University (M.-J.W.); Graduate Institute of Clinical Medical Science, School of Medicine, China Medical University (M.-J.W.); Institute of Biomedical Science and Rong Hsing Research Center for Translation Medicine, National Chung Hsing University (M.-J.W.); and Department of Life Science, Tunghai University (M.-J.W.), Taiwan. Address reprint requests to Ming-Ju Wu, MD, PhD, Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec 4, Taichung 40705, Taiwan. E-mail: [email protected] ª 2014 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 Transplantation Proceedings, 46, 832e834 (2014)

CMV DISEASE AFTER LIVER TRANSPLANTATION national health insurance reimbursement data into files for research purposes. The Taiwan NHIRD includes >99.6% of the total eligible population and provides detailed records of health care services for each patient, including all payments for ambulatory care, inpatient care, patient identification number, birth date, sex, dates of clinical visits, ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnostic codes, and prescriptions. The Taiwan National Health Insurance Bureau and the National Health Research Institutes established and maintain the database. The Institutional Review Board of Taichung Veterans General Hospital waived the requirement for informed consents from the participants, because the data set used in this study consists of nationwide, unidentifiable, secondary data released for research purposes. This waiver does not adversely affect the rights and welfare of the subjects. This retrospective study enrolled all liver transplant recipients in the catastrophic illness database (ICD-9-CM code V42.7) from 2000 to 2009. Cases of cytomegalovirus disease and CMV-related diseases were identified in the admission database with the use of ICD-9-CM codes as follows: CMV (078), pneumonia (484.1), colitis (558.9), hepatitis (078.5), retinitis (362.20), and gastritis (535.0/ 535.1). All enrolled patients were followed from the date of liver transplantation to the date of a first-time diagnosis of CMV disease, death, or the end of follow-up in the medical records. Incidence rates (per 10,000 person years), incidence rate ratios (IRRs), and hazard ratios (HRs) for CMV disease were analyzed. Comorbid disorders were identified at study enrollment. Potential risk factors for the development of CMV disease were considered in a Cox proportional hazards model. To assess the influence of age on the relative risk of CMV disease, we divided all enrollees into 4 age categories:

Cytomegalovirus disease after liver transplantation: a nationwide population-based study.

Cytomegalovirus (CMV) disease is a significant complication after liver transplantation. The estimated incidence varies among studies, which have been...
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