Impact of cytomegalovirus infection, year of transplantation, and donor age on outcomes after liver transplantation for hepatitis C

Kelly W. Burak, Walter K Kremers, Kenneth P. Batts, Russell H. Wiesner, Charles B. Rosen, Raymund R Razonable, Carlos V. Paya, Michael R. Charlton

Research output: Contribution to journalArticle

218 Citations (Scopus)

Abstract

Recurrence of hepatitis C virus (HCV) infection after liver transplantation (LT) is almost universal. However, variables that hasten the progression of allograft injury have not been fully defined. Cytomegalovirus (CMV) is a common infection post-LT, and its impact on the course of post-LT HCV infection remains unclear. We investigated the impact of CMV infection on patient and graft outcomes in 93 consecutive HCV-infected liver transplant recipients. Data were collected prospectively, with surveillance cultures for CMV and protocol liver biopsies. CMV infection (defined as isolation of CMV from blood and treatment with ganciclovir) occurred in 25 patients (26.9%). Graft failure (defined as cirrhosis, relisting for LT, re-LT, or death) was significantly more common in CMV-positive compared with CMV-negative patients (52% v 19.1%; P = .002). Fibrosis stage 2 or greater on the 4-month liver biopsy specimen was more common in CMV-infected patients (45% v 16.4%; P = .01). Patients who underwent LT in more recent years had an increased risk for graft failure. Donor and recipient age, CMV infection, and mycophenolate mofetil use were significantly associated with graft failure in a stepwise multivariate analysis. CMV infection occurs in approximately one quarter of HCV-infected liver transplant recipients and is an independent risk factor for graft failure in these patients. Whether CMV mediates this by inducing increased immunosuppression or directly enhancing HCV replication requires further study.

Original languageEnglish (US)
Pages (from-to)362-369
Number of pages8
JournalLiver Transplantation
Volume8
Issue number4
DOIs
StatePublished - 2002

Fingerprint

Cytomegalovirus Infections
Hepatitis C
Cytomegalovirus
Liver Transplantation
Transplantation
Tissue Donors
Hepacivirus
Transplants
Liver
Virus Diseases
Fibrosis
Mycophenolic Acid
Biopsy
Ganciclovir
Virus Replication
Immunosuppression
Allografts
Multivariate Analysis
Recurrence
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Impact of cytomegalovirus infection, year of transplantation, and donor age on outcomes after liver transplantation for hepatitis C. / Burak, Kelly W.; Kremers, Walter K; Batts, Kenneth P.; Wiesner, Russell H.; Rosen, Charles B.; Razonable, Raymund R; Paya, Carlos V.; Charlton, Michael R.

In: Liver Transplantation, Vol. 8, No. 4, 2002, p. 362-369.

Research output: Contribution to journalArticle

Burak, Kelly W. ; Kremers, Walter K ; Batts, Kenneth P. ; Wiesner, Russell H. ; Rosen, Charles B. ; Razonable, Raymund R ; Paya, Carlos V. ; Charlton, Michael R. / Impact of cytomegalovirus infection, year of transplantation, and donor age on outcomes after liver transplantation for hepatitis C. In: Liver Transplantation. 2002 ; Vol. 8, No. 4. pp. 362-369.
@article{28293ba0288b4f26b31c506998f05220,
title = "Impact of cytomegalovirus infection, year of transplantation, and donor age on outcomes after liver transplantation for hepatitis C",
abstract = "Recurrence of hepatitis C virus (HCV) infection after liver transplantation (LT) is almost universal. However, variables that hasten the progression of allograft injury have not been fully defined. Cytomegalovirus (CMV) is a common infection post-LT, and its impact on the course of post-LT HCV infection remains unclear. We investigated the impact of CMV infection on patient and graft outcomes in 93 consecutive HCV-infected liver transplant recipients. Data were collected prospectively, with surveillance cultures for CMV and protocol liver biopsies. CMV infection (defined as isolation of CMV from blood and treatment with ganciclovir) occurred in 25 patients (26.9{\%}). Graft failure (defined as cirrhosis, relisting for LT, re-LT, or death) was significantly more common in CMV-positive compared with CMV-negative patients (52{\%} v 19.1{\%}; P = .002). Fibrosis stage 2 or greater on the 4-month liver biopsy specimen was more common in CMV-infected patients (45{\%} v 16.4{\%}; P = .01). Patients who underwent LT in more recent years had an increased risk for graft failure. Donor and recipient age, CMV infection, and mycophenolate mofetil use were significantly associated with graft failure in a stepwise multivariate analysis. CMV infection occurs in approximately one quarter of HCV-infected liver transplant recipients and is an independent risk factor for graft failure in these patients. Whether CMV mediates this by inducing increased immunosuppression or directly enhancing HCV replication requires further study.",
author = "Burak, {Kelly W.} and Kremers, {Walter K} and Batts, {Kenneth P.} and Wiesner, {Russell H.} and Rosen, {Charles B.} and Razonable, {Raymund R} and Paya, {Carlos V.} and Charlton, {Michael R.}",
year = "2002",
doi = "10.1053/jlts.2002.32282",
language = "English (US)",
volume = "8",
pages = "362--369",
journal = "Liver Transplantation",
issn = "1527-6465",
publisher = "John Wiley and Sons Ltd",
number = "4",

}

TY - JOUR

T1 - Impact of cytomegalovirus infection, year of transplantation, and donor age on outcomes after liver transplantation for hepatitis C

AU - Burak, Kelly W.

AU - Kremers, Walter K

AU - Batts, Kenneth P.

AU - Wiesner, Russell H.

AU - Rosen, Charles B.

AU - Razonable, Raymund R

AU - Paya, Carlos V.

AU - Charlton, Michael R.

PY - 2002

Y1 - 2002

N2 - Recurrence of hepatitis C virus (HCV) infection after liver transplantation (LT) is almost universal. However, variables that hasten the progression of allograft injury have not been fully defined. Cytomegalovirus (CMV) is a common infection post-LT, and its impact on the course of post-LT HCV infection remains unclear. We investigated the impact of CMV infection on patient and graft outcomes in 93 consecutive HCV-infected liver transplant recipients. Data were collected prospectively, with surveillance cultures for CMV and protocol liver biopsies. CMV infection (defined as isolation of CMV from blood and treatment with ganciclovir) occurred in 25 patients (26.9%). Graft failure (defined as cirrhosis, relisting for LT, re-LT, or death) was significantly more common in CMV-positive compared with CMV-negative patients (52% v 19.1%; P = .002). Fibrosis stage 2 or greater on the 4-month liver biopsy specimen was more common in CMV-infected patients (45% v 16.4%; P = .01). Patients who underwent LT in more recent years had an increased risk for graft failure. Donor and recipient age, CMV infection, and mycophenolate mofetil use were significantly associated with graft failure in a stepwise multivariate analysis. CMV infection occurs in approximately one quarter of HCV-infected liver transplant recipients and is an independent risk factor for graft failure in these patients. Whether CMV mediates this by inducing increased immunosuppression or directly enhancing HCV replication requires further study.

AB - Recurrence of hepatitis C virus (HCV) infection after liver transplantation (LT) is almost universal. However, variables that hasten the progression of allograft injury have not been fully defined. Cytomegalovirus (CMV) is a common infection post-LT, and its impact on the course of post-LT HCV infection remains unclear. We investigated the impact of CMV infection on patient and graft outcomes in 93 consecutive HCV-infected liver transplant recipients. Data were collected prospectively, with surveillance cultures for CMV and protocol liver biopsies. CMV infection (defined as isolation of CMV from blood and treatment with ganciclovir) occurred in 25 patients (26.9%). Graft failure (defined as cirrhosis, relisting for LT, re-LT, or death) was significantly more common in CMV-positive compared with CMV-negative patients (52% v 19.1%; P = .002). Fibrosis stage 2 or greater on the 4-month liver biopsy specimen was more common in CMV-infected patients (45% v 16.4%; P = .01). Patients who underwent LT in more recent years had an increased risk for graft failure. Donor and recipient age, CMV infection, and mycophenolate mofetil use were significantly associated with graft failure in a stepwise multivariate analysis. CMV infection occurs in approximately one quarter of HCV-infected liver transplant recipients and is an independent risk factor for graft failure in these patients. Whether CMV mediates this by inducing increased immunosuppression or directly enhancing HCV replication requires further study.

UR - http://www.scopus.com/inward/record.url?scp=0036250743&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036250743&partnerID=8YFLogxK

U2 - 10.1053/jlts.2002.32282

DO - 10.1053/jlts.2002.32282

M3 - Article

C2 - 11965581

AN - SCOPUS:0036250743

VL - 8

SP - 362

EP - 369

JO - Liver Transplantation

JF - Liver Transplantation

SN - 1527-6465

IS - 4

ER -