ASSOCIATION OF CYTOMEGALOVIRUS (CMV) INFECTION AND DISEASE WITH DEATH AND WITH GRAFT LOSS OR DEATH AFTER LIVER TRANSPLANT IN HIGH RISK RECIPIENTS

Liver transplantation is a life-saving procedure for many forms of end-stage liver disease in pediatrics. Cytomegalovirus (CMV) is the most common and signifi cant posttransplant infection after pediatric liver transplant (PLT) with developing an episode of CMV infection or disease. It is well known that CMV increases risk of graft loss. The review presents aspects of etiology and epidemiology of CMV after PLT, approaches employed in diagnostics and prophylaxis of CMV, algorithms for valganciclovir dosing and methods to prevent complications associated with CMV. The latest data on current prevention strategies in pediatric liver transplantation centers in the world are also presented.

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Pregnancy After Liver Transplant Raises Risk of Graft Loss

Ob Gyn News ◽

10.1016/s0029-7437(11)70214-2 ◽

2011 ◽

Vol 46 (7) ◽

pp. 26

Author(s):

MITCHEL L. ZOLER

Keyword(s):

Liver Transplant ◽

Graft Loss

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Post-transplant absolute lymphocyte count predicts early cytomegalovirus infection after heart transplantation

Scientific Reports ◽

10.1038/s41598-020-80790-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Minjae Yoon ◽

Jaewon Oh ◽

Kyeong-Hyeon Chun ◽

Chan Joo Lee ◽

Seok-Min Kang

Keyword(s):

High Risk ◽

Heart Transplantation ◽

Immunosuppressive Therapy ◽

Lymphocyte Count ◽

Cytomegalovirus Infection ◽

Absolute Lymphocyte Count ◽

Cmv Infection ◽

Igg Antibody ◽

Post Transplant ◽

The Relationship

AbstractImmunosuppressive therapy can decrease rejection episodes and increase the risk of severe and fatal infections in heart transplantation (HT) recipients. Immunosuppressive therapy can also decrease the absolute lymphocyte count (ALC), but the relationship between early post-transplant ALC and early cytomegalovirus (CMV) infection is largely unknown, especially in HT. We retrospectively analyzed 58 HT recipients who tested positive for CMV IgG antibody and received basiliximab induction therapy. We collected preoperative and 2-month postoperative data on ALC and CMV load. The CMV load > 1200 IU/mL was used as the cutoff value to define early CMV infection. Post-transplant lymphopenia was defined as an ALC of < 500 cells/μL at postoperative day (POD) #7. On POD #7, 29 (50.0%) patients had post-transplant lymphopenia and 29 (50.0%) patients did not. The incidence of CMV infection within 1 or 2 months of HT was higher in the post-transplant lymphopenia group than in the non-lymphopenia group (82.8% vs. 48.3%, P = 0.013; 89.7% vs. 65.5%, P = 0.028, respectively). ALC < 500 cells/μL on POD #7 was an independent risk factor for early CMV infection within 1 month of HT (odds ratio, 4.14; 95% confidence interval, 1.16–14.77; P = 0.029). A low ALC after HT was associated with a high risk of early CMV infection. Post-transplant ALC monitoring is simple and inexpensive and can help identify patients at high risk of early CMV infection.

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Comparison of Three Cellular Assays to Predict the Course of CMV Infection in Liver Transplant Recipients

Vaccines ◽

10.3390/vaccines9020088 ◽

2021 ◽

Vol 9 (2) ◽

pp. 88

Author(s):

Smaranda Gliga ◽

Melanie Fiedler ◽

Theresa Dornieden ◽

Anne Achterfeld ◽

Andreas Paul ◽

...

Keyword(s):

Liver Transplant ◽

Solid Organ Transplantation ◽

Solid Organ ◽

Transplant Recipients ◽

Cmv Infection ◽

Cellular Assays ◽

Risk Patients ◽

Ifn Γ ◽

Liver Transplant Recipients

To estimate protection from cytomegalovirus (CMV) replication after solid organ transplantation, CMV serology has been considered insufficient and thus CMV immunity is increasingly assessed by cellular in vitro methods. We compared two commercially available IFN-γ ELISpot assays (T-Track CMV and T-SPOT.CMV) and an IFN-γ ELISA (QuantiFERON-CMV). Currently, there is no study comparing these three assays. The assays were performed in 56 liver transplant recipients at the end of antiviral prophylaxis and one month thereafter. In CMV high- or intermediate-risk patients the two ELISpot assays showed significant correlation (p < 0.0001, r > 0.6) but the correlation of the ELISpot assays with QuantiFERON-CMV was weaker. Results of both ELISpot assays were similarly predictive of protection from CMV-DNAemia ≥500 copies/mL [CMV pp65 T-SPOT.CMV at the end of prophylaxis: area under curve (AUC) = 0.744, cut-off 142 spot forming units (SFU), sensitivity set to 100%, specificity 46%; CMV IE-1 T-Track CMV at month 1: AUC = 0.762, cut-off 3.5 SFU, sensitivity set to 100%, specificity 59%]. The QuantiFERON-CMV assay was inferior, reaching a specificity of 23% when setting the sensitivity to 100%. In conclusion, both CMV-specific ELISpot assays appear suitable to assess protection from CMV infection/reactivation in liver transplant recipients.

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Risk factors predicting Cytomegalovirus infection in post liver transplant recipients

QJM ◽

10.1093/qjmed/hcaa052.005 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M G Abdelrahman ◽

H A Mahmoud ◽

M K Mohsen ◽

M O Ali ◽

A M N Mohamed

Keyword(s):

Risk Factors ◽

Liver Transplantation ◽

Liver Transplant ◽

Organ Transplantation ◽

Chronic Rejection ◽

Cytomegalovirus Infection ◽

Transplant Recipients ◽

Cmv Infection ◽

Donor Liver Transplantation ◽

Liver Transplant Recipients

Abstract Background Liver transplantation is considered to be the only curative treatment for patients with end stage liver disease. Postoperative infection remains to be one of the most common causes of morbidity and mortality throughout the past years. Cytomegalovirus (CMV) infection although considered to be a weak viral infection that usually passes asymptomatic in immunocompetent patients, however, it is considered one of the most common pathogens causing morbidities and mortality in liver transplant recipients. Multiple studies have been done to assess the risk factors for developing CMV infection. Objective Identification of risk factors predicting Cytomegalovirus infection in liver transplant recipients following transplantation. Methods This retrospective study was conducted on 194 patients and their donors who underwent living donor liver transplantation operation at Ain Shams centre for organ transplantation (ASCOT) at Ain Shams specialized hospital in the period between January 2010 and December 2016 with at least one year follow up period after operation for the recipient group. Results In our study, 194 patients undergoing liver transplantation at Ain shams centre for organ transplantation over seven years from January 2010 to December 2016 have been followed to assess risk factors affecting CMV infection development. Chronic rejection was found to be the most common factor associated with CMV infection followed by Cyclosporin (Neoral) as main postoperative immunosuppressant following liver transplantation. Other factors that were found to carry risk for CMV infection included younger age, advanced MELD score, positive CMV IgM status of the donors and recipients. Conclusion Differentiation of Cytomegalovirus disease from Cytomegalovirus infection isn’t always available as it requires tissue invasive techniques. Multiple risk factors have been attributed to cause Cytomegalovirus infection (viremia) . In our study, rejection (chronic rejection) was the factor that carries highest risk for Cytomegalovirus infection development followed by Cyclosporin .

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