Risk factors for cytomegalovirus reactivation after liver transplantation: Can pre‐transplant cytomegalovirus antibody titers predict outcome?

Abstract

Despite preexisting cytomegalovirus (CMV) immunity, CMV-seropositive liver transplantation (LT) patients remain at risk of CMV infection. We hypothesized that the pre-transplant CMV antibody titer correlates with the risk of CMV reactivation. We conducted a retrospective study of CMV-seropositive LT recipients who did not receive anti-CMV prophylaxis from 2007 to 2013. The pre-transplant CMV immunoglobulin G (IgG) titer, which was measured with an enzyme-linked fluorescent immunoassay, was assessed as a risk factor for CMV reactivation with multivariate Cox proportional hazards models. The population consisted of 225 CMV-seropositive LT patients with a median age of 57 years (interquartile range, 47-62 years). The CMV titer distributions were as follows: <60 (40%) and 60 AU/mL (arbitrary unit per milliliter) (60%). The Kaplan-Meier estimates for CMV infection were 17% at 3 months, 18% at 6 months, and 19% at 12 months after transplantation. In a univariate analysis, a marginally significant increased risk of CMV infection was seen in LT recipients with a pre-transplant CMV IgG titer < 60 AU/mL versus 60 AU/mL [hazard ratio (HR), 1.79; 95% confidence interval (CI), 0.98-3.28 (P 5 0.06)]. This risk was statistically significant in the subgroup of recipients who received allografts from CMV-seropositive donors [HR, 2.21; 95% CI, 1.15-4.26 (P 5 0.02)]. In a multivariate analysis, a pre-transplant CMV IgG titer < 60 AU/mL was significantly associated with CMV infection [HR, 3.11; 95% CI, 1.60-6.03 (P < 0.001)]. The other risk factors were high body mass index, donor CMV seropositivity, prolonged cold ischemic time, use of an interleukin-2 receptor antagonist for induction therapy, and high numbers of post-transplant infections. A lower pre-transplant CMV antibody titer is significantly associated with CMV infection after LT. Quantitative measurement of CMV-specific humoral immunity may have a potential role in improving the CMV prevention strategy in CMV-seropositive LT recipients.

Risk factors and long‐term outcomes of pediatric liver transplant recipients with chronic high Epstein‐Barr virus loads

“…Furthermore, multivariate analysis identified WIT, GRWR, and negative of pre‐transplant EBV serostatus of recipients as significant risk factors. Of these 3 factors, prolonged WIT is associated with CMV reactivation after organ transplantation …”

Evaluation of a recombinant multiepitope antigen for diagnosis of hepatitis C virus: A lower cost alternative for antigen production

“…The hepatitis C virus has a significant impact in the public health, and the diagnosis of HCV infection depends on screening methods followed by confirmatory techniques and clinical evaluation to set up the strategies for therapy . The ELISA and related methods are eligible due to lower cost and testing protocol facilities …”

“…ELISA and related assays are the most widely immunological methods used for screening of suspected HCV cases . To allow screening in large‐scale, recombinant antigens were developed, but during many years, the diagnostic industries had the patent rights to antigen production .…”

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“…Interestingly, patients who received an allograft from a CMV-seropositive donor (P < .001) had a significantly increased risk of CMV infection, and in a subgroup analysis of these D+/R+ patients the risk of CMV infection was significantly higher among patients with pretransplant CMV IgG titer of < 60 AU/mL (P = .02). 13 Moreover, in a recent study, Gao and associates demonstrated in rat liver transplant that CMV infection, achieved by intraperitoneal CMV injection, accelerates the process of chronic liver rejection, detected by liver biopsy and blood sample until day 60 after the operation by aggravating bile duct damage, foam cell obliterative arteriopathy, and liver fibrosis. 14 However, in a current update of the international consensus guidelines concerning management of CMV in solid-organ transplant, both treatment strategies prophylaxis versus preemptive therapy were accepted.…”