Cytomegalovirus infection in living donor liver transplant recipients significantly impacts the early post‐transplant outcome: A single center experience

Yadav, Sanjay Kumar; Saigal, Sanjiv; Choudhary, Narendra S.; Saha, Sourav; Sah, Jayant Kumar; Saraf, Neeraj; Kumar, Naveen; Goja, Sanjay; Rastogi, Amit; Bhangui, Prashant; Soin, Arvinder S.

doi:10.1111/tid.12905

Cited by 6 publications

(8 citation statements)

References 18 publications

(18 reference statements)

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“…Despite surgical developments in the field of transplantation, infectious complications remain a major cause of morbidity and mortality for pediatric patients after transplantation. Studies have showed that transplant patients who develop systemic infections could have a worse prognosis (25)(26)(27). In our study, it has been noted that infection rate reached 74.1%, and infection cases took up the majority of adverse events.…”

Section: Discussionsupporting

confidence: 48%

Immune cell function assays in the diagnosis of infection in pediatric liver transplantation: an open-labeled, two center prospective cohort study

et al. 2021

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Background: Limited studies have been performed in assessment of immune status of pediatric liver transplants (PLTs). We conducted this study to evaluate Cylex immune cell function assay in diagnosis of infection and its potential clinical application in Chinese infant PLTs. Methods:In this prospective cohort study, 227 infant PLTs from two medical centers were enrolled, and 216 completed the study. Cylex ATP values were measured before and after liver transplantation (LT) at week 1, 2, 3, 4, 8, 12 and 24 respectively. Accordingly, patients' clinical records, including demographic data, liver function results, tacrolimus dosages and concentrations were collected and analyzed.Results: One hundred and sixty of 216 PLTs (74.1%) were diagnosed infection based on the parameters including abnormal vital signs, imaging changes, and pathogens detection, while 44 (20.4%) were clinically stable and 12 (5.6%) experienced acute rejection. The median Cylex ATP value in infant PLTs post-surgery reduced significantly in infection group compared to stable group (median, 137 vs. 269 ng/mL, P<0.001).Receiver operating characteristic (ROC) curve analysis determined that the cut-off value of Cylex ATP was 152 ng/mL in diagnosis of infection [area under the curve (AUC): 0.784, 95% CI: 0.720-0.848]. Meanwhile, Cylex ATP value showed no correlation to tacrolimus dosage, blood concentration, dose-normalized concentration/dose ratio or Kaup index. However, it tended to correlate weakly with the white blood cell (WBC) number (R =0.462, P<0.0001) and lymphocyte counts (R =0.363, P<0.0001). Conclusions:In this study, we demonstrated that low Cylex ATP represented partly overimmunosuppression and had diagnostic value in infant PLTs with infections, which might assist individualized immunosuppression in PLT patients.

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Section: Discussionsupporting

confidence: 48%

Immune cell function assays in the diagnosis of infection in pediatric liver transplantation: an open-labeled, two center prospective cohort study

et al. 2021

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“…CMV‐related mortality was found to be low in SOT recipients. In eight studies conducted in kidney and/or liver recipients, there were no deaths attributable to CMV in the posttransplant setting 9,25,29,32,41,49,55 . In three other studies, the rate of CMV‐related death caused by pneumonitis concurrent with other bacterial infections was 0.2% (Turkey) 47 and 1.1% (South Korea), 50 and death caused by gastrointestinal disease was 5.3% (Colombia) 30 …”

Section: Resultsmentioning

confidence: 99%

“…The incidence of CMV infection within 1‐year posttransplantation was described in 16 studies, with rates ranging from 10.3% to 63.2% in studies including recipients with various serostatus and in which use of CMV preventive strategy was based on CMV serostatus, also called CMV risk group (9 studies) 21–29 . (Figure S1).…”

Section: Resultsmentioning

confidence: 99%

“…In patients receiving prophylaxis (5 studies), reported rates of CMV infection during the first year post‐SOT were 5.2%, 30 26.0%, 24 45.4%, 31 50.0%, 22 and 50.2% 32 . According to studies conducted in Brazil, India, and South Korea, infection typically appeared after a median of 1–2 months postkidney or postliver transplantation 8,21,25,27,29,32–39 . The diagnostic criteria used for ascertaining CMV infection were similar across studies—whereby a patient was considered to have CMV infection through a positive PCR and/or pp65‐antigenemia assay for CMV.…”

Section: Resultsmentioning

confidence: 99%

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Epidemiology, management, and burden of cytomegalovirus in solid organ transplant recipients in selected countries outside of Europe and North America: A systematic review

Silva

Tokat

Cai

et al. 2023

Transplant Infectious Dis

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BackgroundCytomegalovirus (CMV) is a frequent infectious complication following solid organ transplantation (SOT). Considering significant differences in healthcare systems, a systematic review was conducted to describe the epidemiology, management, and burden of CMV post‐SOT in selected countries outside of Europe and North America.MethodsMEDLINE, Embase, and Cochrane databases were searched for observational studies in SOT recipients across 15 countries in the regions of Asia, Pacific, and Latin America (search period: January 1, 2011 to September 17, 2021). Outcomes included incidence of CMV infection/disease, recurrence, risk factors, CMV‐related mortality, treatment patterns and guidelines, refractory and/or resistant CMV, patient‐reported outcomes, and economic burden.ResultsOf 2708 studies identified, 49 were eligible (n = 43/49; 87.8% in adults; n = 34/49, 69.4% in kidney recipients). Across studies, selection of CMV preventive strategy was based on CMV serostatus. Overall, rates of CMV infection (within 1 year) and CMV disease post‐SOT were respectively, 10.3%–63.2% (9 studies) and 0%–19.0% (17 studies). Recurrence occurred in 35.4%–41.0% cases (3 studies) and up to 5.3% recipients died of CMV‐associated causes (11 studies). Conventional treatments for CMV infection/disease included ganciclovir (GCV) or valganciclovir. Up to 4.4% patients were resistant to treatment (3 studies); no studies reported on refractory CMV. Treatment‐related adverse events with GCV included neutropenia (2%–29%), anemia (13%–48%), leukopenia (11%–37%), and thrombocytopenia (13%–24%). Data on economic burden were scarce. imageConclusionOutside of North America and Europe, rates of CMV infection/disease post‐SOT are highly variable and CMV recurrence is frequent. CMV resistance and treatment‐associated adverse events, including myelosuppression, highlight unmet needs with conventional therapy.

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“…However, these recipients have increased risk of opportunistic infections due to the use of intense immunosuppressive therapy. Among the many pathogens of viral infection that commonly infect LT recipients, cytomegalovirus (CMV) remains the most significant cause of substantial morbidity and mortality [ 2 , 3 , 4 , 5 ]. In the last 2 years, German liver transplant centers have conducted a series of discussions, summarizing the optimal preventive and therapeutic measures for CMV infections after liver transplantation [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Immunohistochemistry Staining-Proven Cytomegalovirus Colitis in Living Donor Liver Transplantation

Lin

Wang

et al. 2022

Viruses

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Background and Aims: Cytomegalovirus (CMV) infection is a common occurrence in liver transplantation (LT) even in an era of preventive strategies. However, the diagnosis of CMV colitis remains challenging. This study aimed to focus on the clinical significance of endoscopic biopsy-proven CMV colitis in patients following living donor liver transplantation (LDLT). Methods: From January 2007 to December 2021, a total of 55 CMV colitis cases were retrospectively enrolled and divided into a non-LDLT group in 53 and an LDLT group in 2 cases. Clinical demographics, diagnostic measurement, histopathology, and anti-viral therapy were investigated. Results: There were 1630 cases undergoing LDLT in the period 2007–2021, with only 2 recipients being confirmed to have CMV colitis in 2021 (2/114, 1-year incidence: 1.75%). Comparisons between the 53 non-LDLT cases and 2 LDLT cases are as follows: Serum anti-CMV immunoglobulin M (IgM) was shown to be positive (n = 3, 5.5% vs. n = 0, p = 1.0) and negative (n = 20, 37.7% vs. n = 2, 100%, p = 0.16); anti-CMV immunoglobulin G (IgG) was positive (n = 19, 35.8% vs. n = 2, 100%, p = 0.14) and none were negative; CMV DNAemia was shown to be detectable (n = 14, 26.4% vs. n = 1, 50%, p = 0.47) and undetectable (n = 14, 26.4% vs. n = 1, 50%, p = 0.47). Among the two recipients with CMV colitis, one had CMV DNAemia and the other had no CMV DNAemia upon the development of symptoms; negative anti-CMV-IgM and positive anti-CMV-IgG were observed both pre-transplant and post-transplant; finally, CMV colitis was documented based on the presence of inclusion bodies and positive immunohistochemistry (IHC) staining in histology. Conclusion: Patients with immunocompromised status, in particular organ transplantation, may have positive serum anti-CMV IgM/IgG antibodies both before and after transplantation. This study emphasized the fact that endoscopic biopsy with IHC staining may be a more powerful tool for making an accurate diagnosis of CMV colitis in the setting of living donor liver transplantation.

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Cytomegalovirus infection in living donor liver transplant recipients significantly impacts the early post‐transplant outcome: A single center experience

Abstract: Cytomegalovirus infection significantly influences the early post LDLT outcomes and contributes to increased overall mortality.

Cited by 6 publications

References 18 publications

Immune cell function assays in the diagnosis of infection in pediatric liver transplantation: an open-labeled, two center prospective cohort study

Immune cell function assays in the diagnosis of infection in pediatric liver transplantation: an open-labeled, two center prospective cohort study

Epidemiology, management, and burden of cytomegalovirus in solid organ transplant recipients in selected countries outside of Europe and North America: A systematic review

Immunohistochemistry Staining-Proven Cytomegalovirus Colitis in Living Donor Liver Transplantation

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