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Cytomegalovirus viremia: risk factor for allograft cirrhosis after liver transplantation for hepatitis C.
- Source :
-
Transplantation [Transplantation] 1997 Sep 15; Vol. 64 (5), pp. 721-6. - Publication Year :
- 1997
-
Abstract
- Background: Despite recent advances in diagnosis and treatment, cytomegalovirus (CMV) infection continues to be a common cause of morbidity in liver transplant (LT) recipients. Because CMV infection suppresses cell-mediated immunity, which seems to be important in neutralizing hepatitis C virus (HCV) infection, we assessed the impact of CMV infection on histopathological HCV recurrence after LT.<br />Methods: The study group was comprised of 43 consecutive LT recipients with at least 6 months of histologic follow-up. Group 1 consisted of the 8 patients who developed CMV viremia after LT; group 2 comprised the 35 patients without CMV viremia. There was no significant difference with regard to age, initial immunosuppression, incidence of rejection, distribution of HCV genotypes, or mean follow-up between the groups. Semiquantitative histopathologic assessment of allograft hepatitis was performed using the Knodell's score.<br />Results: The mean total Knodell score of the final allograft biopsy was significantly greater in group 1 patients (P=0.016), with most of the difference due to periportal/bridging necrosis (P=0.009) and lobular activity subitem (P=0.01) scores. Half of the CMV viremic patients eventually developed allograft cirrhosis as compared with 11% of the CMV-negative patients (P=0.027). Accordingly, the cirrhosis-free actuarial survival by Kaplan-Meier estimates was significantly diminished in the CMV viremic patients. Glycoprotein B genotype analysis of CMV isolates revealed no significant differences between patients who did and those who did not develop allograft cirrhosis.<br />Conclusions: After LT for chronic HCV, patients who develop CMV viremia incur a significantly greater risk of severe HCV recurrence.
- Subjects :
- Antiviral Agents therapeutic use
Biopsy
Cytomegalovirus genetics
Cytomegalovirus Infections prevention & control
Ganciclovir therapeutic use
Genotype
Graft Rejection mortality
Graft Rejection prevention & control
Hepacivirus genetics
Hepatitis C surgery
Humans
Liver Cirrhosis epidemiology
Liver Cirrhosis etiology
Liver Transplantation adverse effects
Middle Aged
Risk Factors
Time Factors
Transplantation, Homologous adverse effects
Transplantation, Homologous pathology
Cytomegalovirus Infections blood
Subjects
Details
- Language :
- English
- ISSN :
- 0041-1337
- Volume :
- 64
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 9311709
- Full Text :
- https://doi.org/10.1097/00007890-199709150-00010