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.
N1 - Funding Information:
From the *Transplant Center, †Division of Infectious Diseases, ‡Section of Biostatistics, and §Department of Pathology, Mayo Clinic and Foundation, Rochester, MN. Supported in part by the American Association for the Study of Liver Diseases/Schering Advanced Hepatology Fellowship (K.W.B.). Address reprint requests to Michael R. Charlton, MD, Mayo Clinic and Foundation, Division of Gastroenterology and Hepatology, 200 First St SW, Rochester, MN 55905. Telephone: 507-266-7045; FAX: 507-266-1856, E-mail: charlton.michael@mayo.edu Copyright © 2002 by the American Association for the Study of Liver Diseases 1527-6465/02/0804-0014$35.00/0 doi:10.1053/jlts.2002.32282
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.
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U2 - 10.1053/jlts.2002.32282
DO - 10.1053/jlts.2002.32282
M3 - Article
C2 - 11965581
AN - SCOPUS:0036250743
SN - 1527-6465
VL - 8
SP - 362
EP - 369
JO - Liver Transplantation
JF - Liver Transplantation
IS - 4
ER -