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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. May 22, 2021; 12(3): 51-58
Published online May 22, 2021. doi: 10.4291/wjgp.v12.i3.51
Impact of cytomegalovirus reactivation just before liver transplantation: A prospective cohort study
Claudio Marcel B Stadnik, Cassia Ferreira B Caurio, Edison M Rodrigues-Filho, Wagner L Nedel, Guido PC Cantisani, Maria L Zanotelli, Alessandro C Pasqualotto
Claudio Marcel B Stadnik, Infection Control Department, Santa Casa de Misericordia de Porto Alegre, Porto Alegre 90075075, RS, Brazil
Cassia Ferreira B Caurio, Alessandro C Pasqualotto, Molecular Biology Laboratory, Santa Casa de Misericordia de Porto Alegre, Porto Alegre 90075075, RS, Brazil
Edison M Rodrigues-Filho, Wagner L Nedel, Intensive Care, Santa Casa de Misericordia de Porto Alegre, Porto Alegre 90075075, RS, Brazil
Guido PC Cantisani, Maria L Zanotelli, Liver Transplant Unit, Santa Casa de Misericordia de Porto Alegre, Porto Alegre 90075075, RS, Brazil
Alessandro C Pasqualotto, Infectious Diseases Unit, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre 90035075, RS, Brazil
Author contributions: Stadnik CMB performed the research, collected and analyzed the data, and wrote the paper; Pasqualotto AC wrote the paper and reviewed of manuscript; Caurio CFB collected data and performed laboratory analyses; Rodrigues-Filho EM, Cantisani GP and Zanotelli ML designed the study and reviewed the manuscript; all authors have read and approved the final manuscript.
Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)–Brazil, No. 479880/2012-3.
Institutional review board statement: This study was approved by the Research Ethics Committee at Santa Casa de Misericordia of Porto Alegre (294/2010).
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Alessandro C Pasqualotto, MD, PhD, Adjunct Professor, Molecular Biology Laboratory, Santa Casa de Misericordia de Porto Alegre, Av Independência 155, Hospital Dom Vicente Scherer, heliponto, Porto Alegre 90075075, RS, Brazil. pasqualotto@ufcspa.edu.br
Received: September 23, 2020
Peer-review started: September 23, 2020
First decision: November 16, 2020
Revised: November 30, 2020
Accepted: February 25, 2021
Article in press: February 25, 2021
Published online: May 22, 2021
BACKGROUND
Cytomegalovirus (CMV) is the most common viral pathogen after liver transplantation (LT). Although reactivation of CMV infection is generally described in the context of immunosuppression, it has also been described in critically ill immunocompetent patients including cirrhotic patients.
AIM
To determine the incidence of reactivated CMV prior to LT.
METHODS
This was a prospective cohort study evaluating adult patients who underwent LT between 2014 and 2016. A plasma sample was obtained from all patients for CMV quantitative real-time PCR testing right before transplantation. Patients were followed for at least 1 year to assess the following outcomes: Incidence of CMV infection, organ rejection and overall mortality.
RESULTS
A total of 72 patients were enrolled. Four patients died before transplantation, thus 68 patients were followed up for a median of 44 mo (20-50 mo). In 23/72 patients (31.9%) CMV was reactivated before transplantation. Post-transplantation, 16/68 (23.5%) patients had CMV infection and that was significantly associated with the recipient being CMV negative and a CMV-positive donor. Pre-transplant CMV reactivation was not associated with overall mortality (log rank: 0.9).
CONCLUSION
This study shows that CMV infection is common in patients with chronic liver disease just before LT, but the clinical impact of this infection seems to be negligible.
Core Tip: Cytomegalovirus (CMV) commonly reactivates before liver transplantation in patients with chronic liver conditions. This prospective cohort study demonstrates for the first time that although frequent, CMV reactivation has limited clinical impact when occurring just before liver transplantation.
