title: Impact of Cytomegalovirus Infection on Severe Hepatitis C Recurrence in Patients Undergoing Liver Transplantation.
abstract: BACKGROUND
  The influence of cytomegalovirus (CMV) on recurrent hepatitis C virus (HCV) in liver grafts is controversial. Our aim was to investigate the association between CMV infection and disease and severe HCV recurrence (composite variable of presence of stage 3 to 4 fibrosis, need for retransplantation or death due to liver disease) in the first year after transplantation.
  
  
  METHODS
  An observational, prospective, multicenter study was performed. The CMV replication was monitored by determining CMV viral load weekly during hospitalization after transplantation, twice monthly in the first 3 months after discharge, and at each follow-up visit until month 12. Liver fibrosis was assessed histologically by liver biopsy or transient elastometry. Pretransplant, intraoperative, and posttransplant variables were recorded. Multiple logistic regression was performed to study the impact of CMV on severe HCV recurrence.
  
  
  RESULTS
  Ninety-eight patients were included. The CMV infection was detected in 48 patients (49%) in the first year posttransplant, of which 11 patients (22.9%) had CMV disease. Twenty-three patients (23.5%) had severe HCV recurrence. Of these, 17 (73.9%) developed stage 3 to 4 fibrosis, 4 (17.4%) died, and 2 (8.7%) underwent retransplantation. Only 7 of 12 (58.3%) seronegative recipients of a seropositive donor (positive donor/negative recipient [D+/R-]) received universal prophylaxis, and 10 of 12 (83.3%) D+/R- patients developed CMV replication. In the multivariate analysis, the presence of CMV D+/R- serodiscordance (odds ratio, 6.87; 95% confidence interval, 1.89-24.99; P = 0.003), and detection of a higher peak HCV viral load (odds ratio, 3.85; 95% confidence interval, 1.49-9.94; P = 0.005) were associated with severe HCV recurrence.
  
  
  CONCLUSIONS
  Our results support an association between CMV D+/R- serodiscordance and severe HCV recurrence in patients undergoing liver transplantation for HCV liver disease.
authors.affiliation: 1 Unit of Infectious Diseases, Hospital General Universitario de Ciudad Real, Spain. 2 Spanish Network for the Research in Infectious Diseases (REIPIRD12/0015), Instituto de Salud Carlos III, Madrid, Spain. 3 Liver Unit-Internal Medicine Department, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas, CIBERehd, Hospital Universitario Vall d'Hebron, Barcelona, Spain. 4 Liver Transplantation Unit, Hospital Clínico Universitario, Santiago de Compostela, Spain. 5 Liver Transplantation Unit, Hospital Universitario Virgen del Rocío, Seville, Spain. 6 Liver Transplantation Unit, Hospital Universitario Reina Sofía-IMIBIC-UCO, CIBERehd, Cordoba, Spain. 7 Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain. 8 Liver Unit, Hospital Universitario Central de Asturias, Oviedo, Spain. 9 Unit of Liver Transplantation, Hospital Universitario de Bellvitge, Barcelona, Spain. 10 Liver Unit, Clínica Universitaria de Navarra, CIBERehd, Pamplona, Spain. 11 Liver Transplantation Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 12 Department of Digestive Diseases, Hospital Universitario Río Hortega, Valladolid, Spain. 13 Clinical Unit of Infectious Diseases, Hospital Universitario Reina Sofía-IMIBIC-UCO, Cordoba, Spain.
authors.forename: Juan Jose
authors.initials: JJ
authors.lastname: Caston
authors.forename: Luis
authors.initials: L
authors.lastname: Castells
authors.forename: Evaristo
authors.initials: E
authors.lastname: Varo
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Gomez
authors.forename: Manuel
authors.initials: M
authors.lastname: de la Mata
authors.forename: Isabel
authors.initials: I
authors.lastname: Campos-Varela
authors.forename: Carlos
authors.initials: C
authors.lastname: Lumbreras
authors.forename: Luisa
authors.initials: L
authors.lastname: Gonzalez-Dieguez
authors.forename: Joan
authors.initials: J
authors.lastname: Fabregat
authors.forename: Ignacio
authors.initials: I
authors.lastname: Herrero
authors.forename: Magdalena
authors.initials: M
authors.lastname: Salcedo
authors.forename: Gloria
authors.initials: G
authors.lastname: Sanchez-Antolín
authors.forename: Julian
authors.initials: J
authors.lastname: Torre-Cisneros
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000628:therapy / Q000821:virology*; D005260:Female; D016174:Hepacivirus / Q000276:immunology / Q000472:pathogenicity*; D006526:Hepatitis C / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000628:therapy / Q000821:virology*; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000276:immunology / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009894:Opportunistic Infections / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000628:therapy / Q000821:virology*; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D014775:Virus Activation
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents