Cytomegalovirus infection after liver transplantation:its effects on rejection and graft / 中国组织工程研究

ABSTRACT

BACKGROUND:Cytomegalovirus is relatively common condition pathogenic virus after liver transplantation. It has many direct or indirect effects on the body, and seriously affects the long-term survival of patients. It should be paid more attention. OBJECTIVE:To analyze and summarize the outcomes of the epidemiology, risk factors, effects on the body, clinical manifestation, diagnosis, treatment and prevention for cytomegalovirus infection after liver transplantation. METHODS:Fitness database, PubMed database and China National Knowledge Infrastructure database were retrieved by computer for articles on cytomegalovirus infection after liver transplantation published from January 2006 to December 2013, and through manual refer to books. Articles were searched with the key words of“liver transplantation, cytomegalovirus infection, risk factors”in Chinese and English. A total of more than 200 articles were retrieved. Forty articles directly related to cytomegalovirus infection after liver transplantation and those published in authoritative magazines were included to review with good representativeness. RESULTS AND CONCLUSION:The positive rate of serum cytomegalovirus-IgG is high in the population. Risk factors of cytomegalovirus infection after liver transplantation include donor-recipient cytomegalovirus serologic status, low serum creatinine clearance, female patients, graft rejection, the use of immunosuppressant and donor-recipient MBL-2 and FCN-2 gene polymorphism. There are direct and indirect effects of this posttransplant opportunistic infection, such as cytomegalovirus syndrome, organ invasion lesions, graft loss, accelerated recurrence of hepatitis C, an increased risk of acute or chronic rejection, predisposition to other opportunistic infections, compromised immunity, accelerated atherosclerosis and the interaction between beta herpes virus. Therefore, prevention and early treatment are very crucial. A combination of pp65 antigen assay for screening and real-time RT-PCR methods for confirmation provides an optimal, low-cost diagnostic regimen for cytomegalovirus infection. Ganciclovir is the first selection for antiviral treatment after liver transplantation, but oral valganciclovir and intravenous ganciclovir are safe, feasible options for preemptive treatment of cytomegalovirus infection after liver transplantation. The plasma levels of CXCL16, PTX3 and von Wil ebrand factor at the start of treatment are independently associated with virologic and clinical treatment failure during anti-cytomegalovirus therapy in solid organ transplant recipients. We should choose different prevention programs for the patients of different donor-recipient cytomegalovirus serologic status.