An association between cytomegalovirus infection and chronic rejection after liver transplantation

Background Previous studies suggest a link between cytomegalovirus (CMV) in fection and chronic rejection. Since these studies, more sophisticated diag nostic methods with high sensitivity and specificity for CMV have been deve loped and effective therapy/prophylaxis for CMV is now available, We sought CMV prospectively by polymerase chain reaction of serum and urine and ky c onventional methods in a group of 33 patients undergoing 57 transplants dur ing 1993 or 1994, selected from a larger series. There were 113 grafts lost to chronic rejection, The remaining 44 grafts that did not develop chronic rejection served as controls and comprised 15 successful primacy grafts, 1 5 second transplants, 8 third transplants, and 6 primary grafts that were l ost for reasons other than chronic rejection. Results. The combination donor CMV antibody negative with recipient, antibo dy positive and the duration of CMV infection >30 days were associated with an increased relative risk of chronic rejection, In contrast, the presence of CMV infection alone, symptomatic CMV infection, the detection of CMV by PCR of serum or urine, and the peak/cumulative viral load! were not predic tive. CMV infection occurred earlier in those undergoing a second transplan t for chronic rejection than for those undergoing a second transplant for o ther reasons. In addition, a human leukocyte antigen B mismatch was associa ted with prolonged CMV infection. Conclusion. These data are consistent with the hypothesis that prolonged su bclinical cytomegalovirus infection is associated with an increased risk of chronic rejection.