ENHANCED (CYTOMEGALOVIRUS) VIRAL REPLICATION ASSOCIATED WITH SEPTIC BACTERIAL COMPLICATIONS IN LIVER-TRANSPLANT RECIPIENTS

Background. Complications of the biliary anastomosis are the principal cause of clinically serious bacterial sepsis in liver transplant reci pients. Reported series suggest an association of bacterial and fungal infection with cytomegalovirus (CMV) infection, although the mechanis m of this association is unclear. Methods. We examined the association of serious bacterial sepsis with CMV replication in a cohort of 106 c onsecutive liver transplant recipients. Sequentially collected buffy c oats were examined with a polymerase chain reaction (PCR) assay that h as been shown to have good predictive value for the development of CMV infection. For selected patients, CMV-specific IgM response and serum tumor necrosis factor-alpha (TNF-alpha were also measured. Results. T en of 13 patients with serious bacterial sepsis developed buffy coat P CR positivity, compared with 26 of 93 patients without bacterial sepsi s (chi-square, P<0.001). Ten of 10 septic recipients with a seropositi ve liver donor developed PCR positivity. For 9 of 10 recipients, bacte rial;sepsis developed before PCR positivity. Bacterial sepsis was asso ciated with high serum levels of TNF-alpha. Immune response to CMV (re flected by the appearance CMV-specific IgM) was apparently affected by bacterial sepsis, and IgM response was not observed for the three sep tic patients who died during the study period. Conclusions. We conclud e that CMV replication is encouraged by serious bacterial sepsis. Repl ication may be promoted by high antecedent levels of TNF-alpha, and/or by poor immune response to CMV in the context of serious bacterial in fection.