Stadnik Claudio Marcel B, Caurio Cassia Ferreira B, Rodrigues-Filho Edison M, Nedel Wagner L, Cantisani Guido Pc, Zanotelli Maria L, Pasqualotto Alessandro C
Infection Control Department, Santa Casa de Misericordia de Porto Alegre, Porto Alegre 90075075, RS, Brazil.
Molecular Biology Laboratory, Santa Casa de Misericordia de Porto Alegre, Porto Alegre 90075075, RS, Brazil.
World J Gastrointest Pathophysiol. 2021 May 22;12(3):51-58. doi: 10.4291/wjgp.v12.i3.51.
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.
To determine the incidence of reactivated CMV prior to LT.
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.
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).
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.
巨细胞病毒（CMV）是肝移植（LT）后最常见的病毒病原体。虽然CMV感染的再激活通常在免疫抑制的背景下被描述，但在包括肝硬化患者在内的重症免疫功能正常的患者中也有相关描述。
确定LT前CMV再激活的发生率。
这是一项前瞻性队列研究，评估2014年至2016年间接受LT的成年患者。在移植前从所有患者获取血浆样本进行CMV定量实时PCR检测。对患者进行至少1年的随访，以评估以下结局：CMV感染的发生率、器官排斥反应和总体死亡率。
共纳入72例患者。4例患者在移植前死亡，因此68例患者接受了中位44个月（20 - 50个月）的随访。在23/72例患者（31.9%）中，CMV在移植前被再激活。移植后，16/68例（23.5%）患者发生CMV感染，且这与受者CMV阴性和供者CMV阳性显著相关。移植前CMV再激活与总体死亡率无关（对数秩检验：0.9）。
本研究表明，LT前慢性肝病患者中CMV感染很常见，但这种感染的临床影响似乎可以忽略不计。
