C. Madalosso et al., CYTOMEGALOVIRUS AND ITS ASSOCIATION WITH HEPATIC-ARTERY THROMBOSIS AFTER LIVER-TRANSPLANTATION, Transplantation, 66(3), 1998, pp. 294-297
Background Hepatic artery thrombosis (HAT) is a cause of morbidity and
graft loss in approximately 7% of patients after an orthotopic liver
transplantation (OLT). Although technical problems are often thought t
o be the cause of HAT, in general the etiology remains unclear. Becaus
e cytomegalovirus (CMV) can infect endothelial cells in vitro and lead
to a rapid procoagulant response, it can be hypothesized that, in the
absence of CMV antibodies, latent CMV in an allograft may become acti
vated and promote or contribute to vascular thrombosis. Therefore, the
purpose of this study was to examine the relationship between CMV ser
ology of the donor and recipient with the development of HAT after OLT
. Methods, Between July 1988 and November 1995 (University of Wisconsi
n era), 490 OLTs were performed in 413 patients. Subsequently, four pa
tients were excluded in whom the CMV serology results of the donor wer
e not available. Sixteen of the 409 patients developed HAT within 30 d
ays after liver transplantation. The control group consisted of the ot
her 393 patients. Results, The incidence of HAT was 12.5% in 64 CMV DR- patients and 0% in 52 CMV D-R- patients. However, in the other comb
inations (D+R+ and D-R+), the incidence was only 2.8% (P=0.005). Eight
of the 16 patients with HAT belonged to the CMV D+R- group. Conclusio
ns. We conclude that CMV-seronegative patients receiving a seropositiv
e allograft may be at risk for early HAT. Seropositivity of the donor
alone and of the recipient alone was not significantly related to the
incidence of HAT. Prophylactic treatment with ganciclovir and/or antic
oagulation should be evaluated to prevent this complication.