Monitoring and Detection of Cytomegalovirus in Liver Transplant Recipients

Human herpesvirus-6 and cytomegalovirus DNA in liver donor biopsies and their correlation with HLA matches and acute cellular rejection

Herpesvirus reactivation is common after liver transplantation.

Objective

Analyze the presence of cytomegalovirus (HCMV) and human herpesvirus-6 (HHV-6) DNA in liver donor biopsies, seeking to better understand issues involving human donor leukocyte antigens (HLA)-A, B and DR, as well as correlations with acute cellular rejection.

Methods

Fifty-nine liver transplantation patients were investigated for the presence of HCMV and HHV-6 DNA in liver donor biopsies, using the Nested-PCR technique. The clinical donor information and HLA matches were obtained from the São Paulo State Transplant System. The recipients’ records regarding acute cellular rejection were studied.

Results

Seven (11.8%) biopsies were positive for HCMV DNA and 29 (49%) were positive for HHV-6 DNA. In 14 donors with HLA-DR 15 nine had HHV-6 DNA positive liver biopsy with a tendency for significant association (p = 0.09), 22 recipients developed acute cellular rejection and 9/22 were positive for HLA-DR 15 (p = 0.03; χ² = 4.51), which was statistically significant in univariate analysis and showed a tendency after multivariate analysis (p = 0.08).

Conclusion

HHV-6 DNA was prevalent in liver donors studied as well as HLA-DR 15. These findings suggest that patients with HLA-DR 15 in liver donor biopsies develop more rejection after liver transplantation.

Identification of bacterial infections and clinical manifestation associated with cytomegalovirus in liver transplantation patients

INTRODUCTION

Liver transplantation has become the most effective therapy for the treatment of patients with end-stage liver disease. With new immunosuppressive agents the incidence of acute rejection has been significantly reduced, but infection has become a serious problem.

OBJECTIVE

Our objective was to correlate cytomegalovirus (CMV) positivity of antigenemia and polymerase chain reaction (PCR) with clinical manifestations and bacterial infections among patients undergoing liver transplantation.

METHODS

This prospective study included patients monitored for 6 months for early detection of CMV infection. Sample collections were performed at the time of surgery and weekly until the second month followed by fortnightly in the third month, and monthly in the fourth to sixth month. CMV infection was defined by positive antigenemia (>3 cells) or 2 positive PCR tests associated or not with clinical symptoms. The methodology for the diagnosis of bacterial infection was through biochemical tests and the automated VITEK/bioMérieux (identification and antibiogram) using samples of urine and blood cultures. Chi-square test was used for dicotomic variables with significant differences when P < .05.

RESULTS

Sixteen patients (32%) had CMV infections, including 13 (81%) with concomitant infections. Thirty-four patients (68%) did not have CMV infections and 8 of these (24%) had bacterial infection. There was a high correlation with bacterial infections among CMV-positive patients.

CONCLUSION

Bacterial infections after liver transplantation were associated with CMV infection.

Co-infection and clinical impact of human herpesvirus 5 and 6 in liver transplantation

BACKGROUND

Human herpesvirus (HHV) 5 and 6 remain latent after primary infection and can be reactivated after immunosuppression for organ transplantation. An association between HHV-5 and HHV-6 has been reported in liver transplant patients. The coinfection is associated with clinical manifestations and graft dysfunction.

OBJECTIVE

The aim of this study was to monitor herpesviruses in liver transplant recipients to better understand issues involving coinfection with HHV-5/6 and correlations with acute cellular rejection episodes and bacterial infections.

METHODS

Forty-five adult liver transplant patients of median age 47 years (range, 18-66), gave blood samples and liver biopsies in the first 6 months after their surgeries. Viremia was detected with the use of nested PCR and antigenemia; the Banff classification was used to detect allograft rejection.

RESULTS

IgG positive for HHV-5 was observed in 94% of subjects whose main indication (67%) for transplantation was hepatitis C. Twenty-three (51.1%) displayed cytomeg virus (CMV) infections and 12 (26.7%) HHV-6 infection. There were 6 patients (13.3%) with HHV-5/6 coinfections. Eighteen of the 23 patients had CMV disease, showing a strong correlation between a positive test and CMV disease; 6 displayed an acute cellular rejection episode in the same period (χ(2) = 6.62; P < .03). Four out of 6 patients who displayed coinfections (HHV-5/6) had concomitant bacterial infections; 3/6 experienced graft rejection episodes. During follow-up, 1 patient had HHV-6 infection diagnosed as encephalitis followed by fever on the 24th day after surgery. The median 32 days for HHV-6 detection by nested PCR positivity was shorter than 38 days for HHV-5.

CONCLUSIONS

HHV-5/6-infected patients displayed more allograft rejection episodes, coinfections, and concomitant bacterial infections, besides an higher risk for CMV disease.

Cytomegalovirus infection among Iranian kidney graft recipients

BACKGROUND

Cytomegalovirus (CMV) infection is one of the most common infectious problems following kidney transplantation. In this study we sought to investigate CMV infection in the setting of renal transplant recipients in Urmia, Iran, using polymerase chain reaction (PCR) detection.

METHODS

Ninety-six randomly selected renal transplant recipient were enrolled in a cross-sectional study. Blood sampling via venipuncture, yielded sera investigated for anti-CMV IgM. Seropositive as well as 14 randomly selected seronegative cases were investigated with PCR assays.

RESULTS

Thirty-three patients (34.3%) were seropositive for anti-CMV IgM; 3 (3.1%) borderline, and 60 (62.5%) seronegative. Considering borderline anti-CMV IgM levels as seropositive, 37.5% were seropositive for anti-CMV IgM. Among the 36 seropositive cases, a CMV infection was confirmed in 19 (52.7%) using PCR. Age (P = .40), educational status (P = .77), history of pretransplantation dialysis (P = .52), prior blood transfusion (P = .52), and immunosuppressive regimen were not significantly different among positive versus negative CMV PCR recipients.

CONCLUSIONS

The seroprevalence of CMV infection was high among renal transplant recipients of Urmia, Iran, as confirmed by PCR study.

Atypical presentation of cytomegalovirus infection in a liver transplant patient

Cytomegalovirus (CMV) is the most common viral infection in solid organ transplant recipients. Symptomatic infection usually presents with fever, pneumonia, colitis, or cytopenia. We describe a case of symptomatic CMV infection in a liver transplant recipient presenting with atypical symptoms of only persistent nausea and vomiting, in the absence of classical symptoms and signs; thus, highlighting the importance of high index of suspicion of CMV in immunocompromised patients, keeping in mind the high morbidity and mortality associated with this disease.