Cytomegalovirus viremia: risk factor for allograft cirrhosis after liver transplantation for hepatitis C

Transplantation. 1997 Sep 15;64(5):721-6. doi: 10.1097/00007890-199709150-00010.


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.

MeSH terms

  • Antiviral Agents / therapeutic use
  • Biopsy
  • Cytomegalovirus / genetics
  • Cytomegalovirus Infections / blood*
  • Cytomegalovirus Infections / prevention & control
  • Ganciclovir / therapeutic use
  • Genotype
  • Graft Rejection / mortality
  • Graft Rejection / prevention & control
  • Hepacivirus / genetics
  • Hepatitis C / surgery
  • Humans
  • Liver Cirrhosis / epidemiology
  • Liver Cirrhosis / etiology
  • Liver Transplantation / adverse effects
  • Middle Aged
  • Risk Factors
  • Time Factors
  • Transplantation, Homologous / adverse effects
  • Transplantation, Homologous / pathology


  • Antiviral Agents
  • Ganciclovir