Cytomegalovirus viremia: risk factor for allograft cirrhosis after liver transplantation for hepatitis C.
| Autor: | Rosen HR; Department of Medicine, Oregon Health Sciences and Portland Veterans Affairs Medical Center, 97207, USA., Chou S, Corless CL, Gretch DR, Flora KD, Boudousquie A, Orloff SL, Rabkin JM, Benner KG |
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| Jazyk: | angličtina |
| Zdroj: | Transplantation [Transplantation] 1997 Sep 15; Vol. 64 (5), pp. 721-6. |
| DOI: | 10.1097/00007890-199709150-00010 |
| Abstrakt: | Background: Despite recent advances in diagnosis and treatment, cytomegalovirus (CMV) infection continues to be a common cause of morbidity in liver transplant (LT) recipients. Because CMV infection suppresses cell-mediated immunity, which seems to be important in neutralizing hepatitis C virus (HCV) infection, we assessed the impact of CMV infection on histopathological HCV recurrence after LT. Methods: The study group was comprised of 43 consecutive LT recipients with at least 6 months of histologic follow-up. Group 1 consisted of the 8 patients who developed CMV viremia after LT; group 2 comprised the 35 patients without CMV viremia. There was no significant difference with regard to age, initial immunosuppression, incidence of rejection, distribution of HCV genotypes, or mean follow-up between the groups. Semiquantitative histopathologic assessment of allograft hepatitis was performed using the Knodell's score. Results: The mean total Knodell score of the final allograft biopsy was significantly greater in group 1 patients (P=0.016), with most of the difference due to periportal/bridging necrosis (P=0.009) and lobular activity subitem (P=0.01) scores. Half of the CMV viremic patients eventually developed allograft cirrhosis as compared with 11% of the CMV-negative patients (P=0.027). Accordingly, the cirrhosis-free actuarial survival by Kaplan-Meier estimates was significantly diminished in the CMV viremic patients. Glycoprotein B genotype analysis of CMV isolates revealed no significant differences between patients who did and those who did not develop allograft cirrhosis. Conclusions: After LT for chronic HCV, patients who develop CMV viremia incur a significantly greater risk of severe HCV recurrence. |
| Databáze: | MEDLINE |
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