Resumen

PRIETO, Jimena et al. Determination of a Viral Load Cut-off for Preemptive Therapy in Liver Transplant Recipients with Intermediate Risk for Cytomegalovirus. Rev. Méd. Urug. [online]. 2025, vol.41, n.4, e206.  Epub 31-Oct-2025. ISSN 0303-3295.  https://doi.org/10.29193/rmu.41.4.6.

Cytomegalovirus (CMV) is an important cause of morbidity in liver transplant (LT) recipients, especially in those at intermediate risk, defined as seropositive patients who do not receive induction with lymphocyte-depleting agents. In this group, the preemptive therapy strategy based on virological monitoring allows for the early initiation of antiviral treatment. However, its effectiveness depends on establishing an optimal viral load threshold to guide intervention.

The aim of this study was to determine the optimal plasma CMV viral load cut-off for initiating preemptive therapy in LT recipients at intermediate risk at the National Liver Transplant Center (CENATH), Montevideo, Uruguay. A single-center retrospective study was conducted, including seropositive LT or liver-kidney transplant recipients without the use of thymoglobulin, transplanted between January 2017 and June 2024. A total of 173 viremia episodes in 143 patients were analyzed using quantitative plasma PCR. ROC curve analysis and Youden’s index were used to determine the optimal cut-off.

Progression to CMV disease was documented in 3 cases (1.9%), all with viral loads >2595 IU/ml. Patients with disease presented significantly higher viral loads (mean: 21,800 vs. 1373 IU/ml; p<0.05). ROC analysis yielded an AUC of 0.986 (95% CI: 0.967–1.000). The threshold of 2595 IU/ml showed a sensitivity of 100% and specificity of 86.4%.

This value demonstrated excellent performance for guiding preemptive therapy, optimizing the use of antivirals. A prospective validation is underway.

Palabras clave : Cytomegalovirus; Liver transplant; Viremia; Preemptive therapy; Viral load; ROC curve.

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