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KMID : 0870419980020020093
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
1998 Volume.2 No. 2 p.93 ~ p.99
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Cytomegalovirus Infection after Orthotopic Liver Transplantation
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Kim Sung-Ju
Cho Jae-Won
Park Yeon-Ho
Lee Woo-Yong
Sohn Tae-Sung
Choi Seong-Ho
Lee Suk-Koo
Kim Sung-Min
Peck Kyong-Ran
Song Jae-Hoon
Kim Mi-Kyung
Yang Yoon-Sun
Kim Yong-Il
Lee Byung-Boong
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Abstract
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Background/Aims: Cytomegalovirus (CMV) is an important pathogen following orthotopic lived trans-plantation (OLT) which increases morbidity and mortality significantly. We reviewed our experiences of CMV infection in liver transplant to evaluate various monitoring techniques and the effect of ganciclovir treatment regimen.
Materials and Methods: From May 1996 to Feb 1998, 34 consecutive liver transplantations in 33 patients were performed at our hospital, including 12 living-related liver transplantations. Screening of CMV infection was carried out weekly by several means, such as serological test, antigenemia assay, polymerase chain reaction (PCR) and viral culture in urine, sputum, and blood. Histopathologic diagnosis of tissue-invasive CMV disease, using immunostaining and in situ hybridization, was carried out, if clinically indicated.
Result: Overall, CMV injection occurred in 10(29.4%) patients of the 34 liver transplants. The CMV antigenemia
was detected in 8(80%) patients and 5 patients among them developed symptomatic CMV disease. The PCR test was positive in 7(70%) patients before the antigenemia was detected and continued to be positive in 4 patients after negative conversion of antigenemia. Seven(70%) of the 10 CMV infected patients developed symptomatic or tissue invasive CMV disease, including five CMV hepatitis and two CMV pneumonia. There was no remarkable culture evidence of CMV in these patients. Among these , one CMV hepatitis patient and another CmV pneumonia patient died due to posttransplant lymphoproliferative disease. The antigenemia was completed resolved in CMV-infected patients after ganciclovir therapy. There was no CMV-related mortality in our series.
Conclusion: The role that CMV antigenemia and PCR detection of viral DNA play in the prediction of subsequent CMV tissue invasion remains to defined, but the antigenemia assay was a reliable marker in monitoring for CMV and a guide to preemptive therapy.
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KEYWORD
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Cytomegalovirus, Liver transplantation, Antigenemia
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