Association of cytomegalovirus genotype with graft rejection after liver transplantation

Background. The envelope glycoprotein gB of human cytomegalovirus (CMV) occ urs as one of four main genotypes, Some previous studies have proposed a re lationship of CMV gB genotype to the frequency of symptomatic infection and to clinical outcomes in both transplant and human immunodeficiency virus-i nfected populations. Our aim was to define the distribution of CMV gB genot ypes and the impact on acute cellular rejection and graft/patient survival after orthotopic liver transplantation (OLT). Methods. Between October 1988 and December 1996, 325 patients underwent cyc losporine-based OLT at our center. CMV infection was surveyed prospectively and defined as viral isolation from blood or urine; 53 (16%) patients had detectable CMV, Isolates were genotyped by polymerase chain reaction amplif ication and restriction digest analysis. Results. The distribution of CMV genotypes was: gB1, 19 (36%) patients; gB2 , 15 (28%) patients; gB3, 13 (24%) patients; and gB4, 4 (8%) patients. Two patients (4%) had mixed infection (1 + 3, 1 + 4), Age, preOLT diagnosis, us e of ganciclovir prophylaxis, basal immunosuppression, mean number of HLA d onor/recipient mismatches, and United Network of Organ Sharing status were comparable among patients with different genotypes. Patients with gB1 had a significantly higher mean number of acute rejection episodes (1.52+/-0.30 vs. 0.67+/-0.22; P=0.027). However, there was no difference in rejection se verity, including OKT3 usage or FK506 conversion, or development of chronic rejection among patients with different genotypes. The gB genotype did not affect the development of symptomatic or tissue-invasive CMV disease, dete cted in 15 patients. Actuarial rates of patient (odds ratio [OR] 3.0; confi dence interval [CI] 1.49-6.0) and graft (OR 2.57; CI 1.25-5.22) survival we re significantly diminished in the group with CMV infection versus those wi thout CMV (P<0.0001 for both), but there was no association with CMV genoty pe. Conclusions. (1) Patients with CMV infection had significantly reduced pati ent and graft survival rates at 1 and 5 years after OLT as compared with OL T recipients without CMV infection. (2) CMV genotype gB1 was associated wit h a higher mean number of acute rejection episodes.