Post-Liver Transplant Cytomegalovirus (CMV) Reactivation, Graft, and Patient Survival Rates in Iranian Population

Abstract

Background: Human cytomegalovirus (CMV) is the major complication of viral infection in immunocompromised patients. This opportunistic infection is associated with high morbidity and mortality in transplanted recipients. Objectives: The present study aimed to determine CMV burden and assess the clinical outcome in the liver recipients with CMV reactivated infection at Nemazi Hospital, Shiraz, Iran. Methods: This retrospective study examined 657 patients who underwent liver transplantation during 2014 - 2017 to identify the CMV infection, morbidity, and mortality rates. To this end, the medical records of such patients were reviewed, and their rejection/survival rates were analyzed. Accordingly, the CMV infection was diagnosed by Taq-Man real-time PCR assays. Results: In this study, 151 (23%) had CMV reactivation at least one year after liver transplantation. Viremic patients had a viral burden between 300 - 738790 copies/mL. In this study, 41 persons (6.2%) died, and 58 LT patients (8.8%) had rejection experience up to one year after their operation. Among the 41 dead patients, 21 and 20 cases were with and without CMV-reactivation, respectively. The results demonstrated that the mortality rate was significantly higher in the CMV-infected patients than the non-CMV-infected counterparts. In contrast, the graft survival rate was not significantly different between the two groups (P ≤ 0.05). Conclusions: In the present study, CMV infection can serve as a significant mortality predictor in LT patients.

Detrimental impact of immunosuppressive burden on clinical course in patients with Cytomegalovirus infection after liver transplantation

“…We found a striking adverse impact of CMV‐infection on survival, reflecting the importance of thorough adherence to prophylaxis or even preemptive therapy recommendations and screening post‐LT. Other studies have reported similar observations, but interestingly, CMV‐infection itself can only rarely be linked directly to graft failure or death 24,60,61 . However, we found a dosage‐dependent effect of IS on extent of CMV‐infection.…”

“…Other studies have reported similar observations, but interestingly, CMV-infection itself can only rarely be linked directly to graft failure or death. 24,60,61 However, we found a dosage-dependent effect of IS on extent of CMV-infection.…”