{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:44:11Z","timestamp":1753879451944,"version":"3.41.2"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T00:00:00Z","timestamp":1673308800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Advanced liver disease or cirrhosis is associated with an increased risk of infections; however, the impact of high pretransplant model for end\u2010stage liver disease (MELD) score on cytomegalovirus (CMV) viremia after liver transplantation is unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This single\u2010center, retrospective, cohort study evaluated CMV high\u2010risk (CMV immunoglobulin G D+\/R\u2212) liver transplant recipients who received valganciclovir prophylaxis for 3 months between 2009 and 2019. Patients were stratified by pretransplant MELD score of &lt;35 (low MELD) and \u226535 (high MELD). The primary outcome was 12\u2010month CMV viremia, and secondary outcomes included CMV resistance and tissue invasive disease, mortality, biopsy\u2010proven acute rejection (BPAR), leukopenia, and thrombocytopenia. Multivariable Cox proportional\u2010hazards modeling was used to assess the association of MELD score with the time to CMV viremia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 162 and 79 patients in the low and high MELD groups, respectively. Pretransplant MELD score \u226535 was associated with an increased risk of CMV viremia (hazard ratio [HR] 1.73; confidence interval 1.06\u20132.82, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.03). CMV viremia occurred at 162\u00a0\u00b1\u00a061 days in the low MELD group and 139\u00a0\u00b1\u00a062 days in the high MELD group. Although BPAR occurred early at 30 days (13\u201359) in the low\u2010MELD group and at 18 days (11\u201366) in the high\u2010MELD group (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.56), BPAR was not associated with an increased risk of CMV viremia (HR 1.55 [0.93\u20132.60], <jats:italic>p<\/jats:italic>\u00a0=\u00a0.1).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>MELD scores \u226535 were associated with an increased hazards of CMV viremia. In liver transplant recipients with MELD scores \u226535 who are CMV high\u2010risk, additional CMV intervention may be warranted.\n<jats:boxed-text content-type=\"graphic\" position=\"anchor\"><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/tid14001-gra-0001-m.png\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:boxed-text><\/jats:p><\/jats:sec>","DOI":"10.1111\/tid.14001","type":"journal-article","created":{"date-parts":[[2022,12,12]],"date-time":"2022-12-12T18:29:32Z","timestamp":1670869772000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of high MELD scores on CMV viremia following liver transplantation"],"prefix":"10.1111","volume":"25","author":[{"given":"Sari R.","family":"Freedman","sequence":"first","affiliation":[{"name":"Department of Pharmacy University of Maryland Medical Center  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth","family":"Saunders","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University of Maryland School of Pharmacy  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael E.","family":"Plazak","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University of Maryland Medical Center  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bharath R.","family":"Ravichandran","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University of Maryland School of Pharmacy  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kapil K.","family":"Saharia","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Medicine University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian M.","family":"Masters","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University of Maryland Medical Center  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8305-7296","authenticated-orcid":false,"given":"Tracy","family":"Sparkes","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University of Maryland Medical Center  Baltimore Maryland 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