Management of cytomegalovirus infection and disease in liver transplant recipients

Table 1 Direct and indirect clinical effects of cytomegalovirus after liver transplantation

Direct effects	Indirect effects
CMV syndrome	Acute allograft rejection
Fever	Chronic allograft rejection
Myelosuppression	Vanishing bile duct syndrome
Malaise	Chronic ductopenic rejection
Tissue-invasive CMV disease1	Hepatitis C virus recurrence
Gastrointestinal disease	Allograft hepatitis, fibrosis
(colitis, esophagitis, gastritis,	Allograft failure
enteritis)	Opportunistic and other infections
Hepatitis	Fungal superinfection
Pneumonitis	Nocardiosis
CNS disease	Bacterial superinfection
Retinitis	Epstein-Barr virus and PTLD
Mortality	HHV-6 and HHV-7 infections
	Vascular thrombosis
	New onset diabetes mellitus
	Mortality

¹Any organ system may be affected by cytomegalovirus (CMV). Data adapted from Ref. [104]. PTLD: Post-transplant lymphoproliferative disease; HHV: Human herpes virus.