The influence of cytomegalovirus viraemia on the outcome of recurrent hepatitis C after liver transplantation

Background. Several interrelated host and hepatitis C virus (HCV) associate d factors have been proposed to explain the variable outcomes in HCV recurr ence. Recent evidence suggests that cytomegalovirus (CMV) infection not onl y is co-factor in progression of HCV recurrence but may precipitate allogra ft rejection. We investigated whether short-term CMV viremia influences HCV recurrence, the number and grade of acute rejection episodes, and the hist ological course of HCV recurrence during the first year after orthotopic li ver transplantation (OLT) for HCV-related cirrhosis. Methods A cohort of 39 patients transplanted for cirrhosis HCV-related was analyzed. Patients were evaluated twice weekly for CMV infection by a blood polymerase chain reaction (PCR) assay. Triple therapy with cyclosporine or tacrolimus, azathioprine and prednisolone was the initial immunosuppressiv e regimen. Preemptive treatment with ganciclovir was started when two conse cutive PGRs for CMV were positive. Liver biopsies were performed on day 7 a fter OLT or when indicated. A 3-day IV 1 g methilprednisolone was given to patients with moderate or severe rejection. Ishak's score was used to grade inflammation and to stage fibrosis. Results Neither CMV viremia nor CMV disease after OLT for HCV-related cirrh osis adversely influenced the incidence and grade of acute rejection episod es nor the histological outcome of post transplant HCV recurrence, during t he first year after liver transplantation. Conclusion CMV viremia as detected by PCR does not affect the progression o f HCV recurrence in liver grafts.