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P429. Long-term outcomes of cytomegalovirus reactivation in patients with moderate to severe ulcerative colitis: a multicenter study

Y.S. Kim1, Y.-H. Kim2, J.S. Kim3, J.h. Cheon4, B.D. Ye5, H.J. Jung1, S.J. Park4, S.-A. Jung6, Y.S. Park7, C.H. Choi8, K.O. Kim9, B.I. Jang9, D.S. Han10, S.-K. Yang5, W.H. Kim4, 1Inje University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 2Sungkyunkwan University School of Medicine, Internal Medicine, Seoul, Korea, Republic of, 3Seoul National University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 4Yonsei University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 5University of Ulsan College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 6Ewha Womans University, Internal medicine, Seoul, South Korea, 7Eulji university, School of medicine, Department of Gastrieneteriology, Seoul, Korea, Republic of, 8Chung-Ang University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 9Yeungnam University College of Medicine, Internal Medicine, Daegu, Korea, Republic of, 10Hanyang University Guri Hospital, Gastroenterology, Guri, Korea, Republic of

Background

Our previous study reported that cytomegalovirus (CMV) reactivations are frequently observed in patients with moderate to severe ulcerative colitis (UC) and that ganciclovir therapy was effective in patients with steroid-refractory UC. However, the long term clinical outcome of CMV reactivation is not determined yet. The aim of this study is to determine the long-term outcomes of CMV infections in patients with active UC, as well as the long-term therapeutic efficacy of ganciclovir treatment on CMV reactivation.

Methods

This retrospective, multicenter study included a cohort of 72 patients with moderate to severe UC who were evaluated for CMV reactivation at their initial ulcerative colitis flare. The 72 patients were grouped into a CMV-positive (n = 31) and CMV-negative group (n = 41) according to the results of CMV assessment at the initial UC flare-up. Colectomy, disease relapse, and recurrence rate of CMV reactivation were investigated.

Results

The mean duration of follow-up for the 72 patients was 43.35±20.92 months (range, 1–69 months). The cumulative colectomy (log rank P = 0.003) and disease flare-up rates (log rank P = 0.048) were significantly higher in the CMV-positive group. Of the 11 patients who were successfully treated with ganciclovir in the initial treatment, 3 (27.3%) experienced a recurrence of CMV reactivation and 5 (55.6%) showed a poor outcome such as need for colectomy or a steroid-dependent state.

Conclusion

Patients who had CMV reactivated UC showed poor outcomes at the long-term follow-up, and the long-term efficacy of ganciclovir therapy was marginal. Careful assessment is necessary for patients with moderate to severe UC who have evidence of CMV reactivation.