Cytomegalovirus infection and donor/recipient HLA antigens: interdependent co-factors in pathogenesis of vanishing bile-duct syndrome after liver transplantation

Lancet. 1988 Aug 6;2(8606):302-5. doi: 10.1016/s0140-6736(88)92356-2.


The contribution of cytomegalovirus (CMV) infection and its interrelation with HLA antigens in the development of chronic rejection (vanishing bile-duct syndrome--VBDS) was investigated in 101 patients surviving for at least 3 months after liver transplantation. A 1-2 antigen match for HLA DR antigens (30.9% vs 4.5% for zero DR match; p less than 0.002), a zero match for HLA A/B antigens (27.5% vs 10.9% for 1 or more A/B match; p less than 0.05), and active CMV infection (26.3% vs 4.4% for no CMV infection; p less than 0.005) were independently associated with an increased risk of VBDS. The coexistence of a 1-2 HLA DR match and CMV infection carried the highest relative risk (10.1) of VBDS; these two variables were probably interdependent since either alone was associated with a low relative risk (0.45 and 0.5). The association between VBDS and active CMV infection was not a consequence of alterations in immunosuppressive therapy. The findings would be consistent with precipitation of chronic rejection by CMV-induced HLA antigen expression in patients rendered susceptible by the donor/recipient HLA antigen match.

MeSH terms

  • Adolescent
  • Adult
  • Bile Duct Diseases / etiology*
  • Bile Duct Diseases / immunology
  • Cytomegalovirus Infections / immunology*
  • Graft Rejection
  • HLA Antigens / immunology*
  • HLA-A Antigens
  • HLA-DR Antigens / immunology
  • Histocompatibility Testing
  • Humans
  • Liver Transplantation*
  • Middle Aged


  • HLA Antigens
  • HLA-A Antigens
  • HLA-DR Antigens