Cytomegalovirus and posttransplant biliary complications: Elusive offender or innocent bystander?

Bittermann, Therese; Goldberg, David S.

doi:10.1002/lt.23727

Cited by 5 publications

(3 citation statements)

References 13 publications

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“…The persistence of beta-herpesviruses in epithelia after LT has been described frequently [16]. Cytomegalovirus in bile has already been implicated in biliary lesion formation after LT, but its significance remains controversial [4, 17, 18]. Interestingly, in our study, the rates of detection of CMV, HHV-6 and HHV-7 in bile have been considerably higher than in serum or liver biopsies (Table 2).…”

Section: Discussionmentioning

confidence: 50%

Prevalence of human herpesviruses in biliary fluid and their association with biliary complications after liver transplantation

et al. 2019

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Background Beta-herpesviruses are common opportunistic pathogens that cause morbidity after liver transplantation (LT). Methods Objective of the study was to evaluate the prevalence and correlation of herpesviruses in bile, blood and liver tissue and to investigate their association with biliary complications and retransplantation (re-LT) free survival after LT. The study design is a single-center case-control study. We performed quantative polymerase chain reaction (qPCR) for herpesvirus 1–8 DNA in bile, blood and liver tissue of 73 patients after first LT and analyzed their clinical courses retrospectively. Results The median follow-up was 48 months (range 2–102), during which a total of 16 patients underwent re-LT and 11 patients died. Of the patients, 46.5% received valganciclovir prophylaxis at the time of bile sample acquisition. Cytomegalovirus (CMV) (18.3%), human herpesvirus 6 (HHV-6) (34.2%), human herpesvirus 7 (HHV-7) (20.5%) and Epstein-Barr virus (EBV) (16.4%) were highly prevalent in bile after LT, while herpes simpex virus 1 and 2 (HSV-1, HSV-2), varicella-zoster virus (VZV) and human herpesvirus 8 (HHV-8) were not or rarely detected in bile. Valganciclovir prophylaxis did not reduce the prevalence of HHV-6 and HHV-7 in bile, but it did reduce the presence of CMV and EBV. The presence of HHV-6 in bile was associated with non-anastomotic biliary strictures (NAS) and acute cellular rejection (ACR). Conclusions CMV, EBV, HHV-6 and HHV-7 are more prevalent in biliary fluid than in liver biopsy or blood serum after LT. HHV-6 and HHV-7 might be associated with biliary complications after LT. Biliary fluids might be an attractive target for routine herpesvirus detection.

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Section: Discussionmentioning

confidence: 50%

Prevalence of human herpesviruses in biliary fluid and their association with biliary complications after liver transplantation

et al. 2019

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“…19 Halme et al reported that CMV infection is a risk factor for the development of biliary complications after LT, 20 and Gotthardt et al found that CMV DNA was detected more frequently in the bile of LT patients with nonanastomotic biliary lesions. 21 CMV was also reported to be a risk factor for the recurrence of PSC after living-donor LT. 22 Even though the correlation between CMV and biliary complications has not been confirmed in all studies and is controversial, [23][24][25] there still is increasing evidence of an association between CMV and biliary diseases, an association that was confirmed in the present study.…”

Section: Risk Of CMV Infection Without Defined Immunosuppression (%) P Valuesupporting

confidence: 49%

Primary sclerosing cholangitis as an independent risk factor for cytomegalovirus infection after liver transplant

Rashidi-Alavijeh

Crämer

Sauter

et al. 2021

Transplant Infectious Dis

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Cytomegalovirus (CMV) is one of the most common pathogens causing morbidity and mortality after solid organ transplant (SOT). 1,2 CMV infections are mostly asymptomatic among immunocompetent patients, but they exhibit lifelong latency and reactivate when the immune system is impaired, as it is among immunosuppressed patients after SOT. 3,4 Among liver transplant (LT) patients, CMV infection can occur due to reactivation after transplantation or due to primary infection caused by a CMV-positive donor. It is important

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“…CMV infection and its relationship with a higher occurrence of biliary complications have been the subject of discussion 3,7,9,10 . In this sense, the high percentage of individuals serologically positive for CMV in Brazil stands out -a prevalence of 80 to 100% -compared to a prevalence of 40 to 60% in developed countries 21,26,31 .…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Post-Liver Transplant Biliary Complications in the Absence of Arterial Complications

Lima

Pereira

Jungmann³

et al. 2020

ABCD, arq. bras. cir. dig.

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Background - Biliary complications (BC) represent the most frequent complication after liver transplantation, up to 34% of cases. Aim: To identify modifiable risk factors to biliary complications after liver transplantation, essential to decrease morbidity. Method: Clinical data, anatomical characteristics of recipient and donors, and transplant operation features of 306 transplants with full arterial patency were collected to identify risk factors associated with BC. Results: BC occurred in 22.9% after 126 days (median) post-transplantation. In univariate analyses group 1 (without BC, n=236) and group 2 patients (with BC, n=70) did not differ on their general characteristics. BC were related to recipient age under 40y (p=0.029), CMV infection (p=0.021), biliary disease as transplant indication (p=0.018), lower pre-transplant INR (p=0.009), and bile duct diameter <3 mm (p=0.033). CMV infections occurred sooner in patients with postoperative biliary complications vs. control (p=0.07). In a multivariate analysis, only CMV infection, lower INR, and shorter bile duct diameter correlated with BC. Positive CMV antigenemia correlated with biliary complications, even when titers lied below the treatment threshold. Conclusions: Biliary complications after liver transplantation correlated with low recipient INR before operation, bile duct diameter <3 mm, and positive antigenemia for CMV or disease manifestation. As the only modifiable risk factor, routine preemptive CMV inhibition is suggested to diminish biliary morbidity after liver transplant.

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Cytomegalovirus and posttransplant biliary complications: Elusive offender or innocent bystander?

Cited by 5 publications

References 13 publications

Prevalence of human herpesviruses in biliary fluid and their association with biliary complications after liver transplantation

Prevalence of human herpesviruses in biliary fluid and their association with biliary complications after liver transplantation

Primary sclerosing cholangitis as an independent risk factor for cytomegalovirus infection after liver transplant

Risk Factors for Post-Liver Transplant Biliary Complications in the Absence of Arterial Complications

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