title: Association of cytomegalovirus infection and disease with recurrent hepatitis C after liver transplantation.
abstract: BACKGROUND
  Cytomegalovirus (CMV) has been inconsistently associated with recurrent hepatitis C virus (HCV) after liver transplant (LT).
  
  
  METHODS
  A retrospective study of 347, donor or recipient CMV seropositive, first LT recipients transplanted for HCV was performed to evaluate the associations of CMV infection and disease occurring within 1-year of LT with the primary endpoints of allograft inflammation grade ≥2 and fibrosis stage ≥2. Associations were evaluated using multivariable Cox regression models.
  
  
  RESULTS
  CMV infection and disease occurred in 111 (32%) and 24 (7%) patients, respectively. Hepatic allograft inflammation grade ≥2 and fibrosis stage ≥2 occurred in 221 (64%) and 140 (40%) patients, respectively. CMV infection was associated with increased risk of fibrosis stage ≥2 (relative risk [RR], 1.52; P=0.033). CMV disease was associated with increased risk of inflammation grade ≥2 (RR, 3.40; P<0.001), and although not significant, with fibrosis stage ≥2 (RR, 2.03; P=0.052). These associations did not differ significantly according to recipient CMV seropositivity.
  
  
  CONCLUSIONS
  Our results support an association between CMV infection and disease with recurrence of HCV after LT. Investigation of prevention of CMV infection and disease as a strategy to mitigate recurrent HCV in LT recipients is warranted.
authors.affiliation: Division of Infectious Diseases, Mayo Clinic in Florida, Jacksonville, FL, USA.
authors.forename: Wendelyn
authors.initials: W
authors.lastname: Bosch
authors.forename: Michael G
authors.initials: MG
authors.lastname: Heckman
authors.forename: Surakit
authors.initials: S
authors.lastname: Pungpapong
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Diehl
authors.forename: Jefree A
authors.initials: JA
authors.lastname: Shalev
authors.forename: Walter C
authors.initials: WC
authors.lastname: Hellinger
mesh_terms: D000328:Adult; D000368:Aged; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D005260:Female; D005431:Florida; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality; D006085:Graft Survival; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000401:mortality / Q000821:virology*; D017093:Liver Failure / Q000401:mortality / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome