ABSTRACT
Randomized trials have also evaluated the efficacy of standard immunoglobulin and CMVIG in liver and other solid organ transplants. These trials are summarized in Table 2. In liver transplant recipients, standard immunoglobulin does not appear to reduce the incidence of CMV infection or disease (20). Snydman and co-workers demonstrated a significant reduction in severe CMV disease and in the number of fungal and parasitic infections with CMVIG in a trial of all serostrata of liver transplant recipients, although the subset of D+/R-liver transplant recipients did not appear to benefit (21). However, a subsequent analysis of that study (22) and an earlier study (23) did reveal some reduction in CMV disease in D+/R-recipients given CMVIG. As in renal transplantation, the data on the effects that immunoglobulins have on graft survival and mortality in liver transplantation are not certain. In one study, 1-year graft survival was improved with the use of CMVIG when compared to placebo recipients, although these results did not reach statistical significance (22). Data in two studies demonstrated weak statistical trends in improvement in survival (21,24). The use of standard immunoglobulin with acyclovir as preemptive therapy in high-risk liver transplant patients receiving OKT3 did not reduce the incidence of CMV infection (24), although the incidence of HSV, EBV, and fungal infections were reduced with such therapy.
