Risk Factors For Early Cytomegalovirus Infection After Liver Transplantation

Objective:Human cytomegalovirus(HCMV)is the most common opportunistic infection in liver transplant recipients.The identification of risk factors in the first 90 days post-transplant during preemptive therapy might help to better supervise early HCMV infection post-LT.Methods:150 patients aged 14 and older who underwent LT and received preemptive therapy for HCMV infection in the First Affiliated Hospital,Zhejiang University from July 2017 to December 2018 were enrolled.This retrospective single-center study analyzed risk factors for HCMV infections in the first 90 days post-LT.Results:32 patients(21.33%)developed HCMV replication at a median of 29 days after liver transplant with a median peak viral load of 83605 copies/ml.HCMV DNA viral load was positively correlated with liver enzymes(ALT and AST).We identified ICU length of stay(OR=1.055,95%CI 1.007-1.104,P = 0.023),fungal infections(OR=3.093,95%CI 1.092-8.764,P=0.034)and non-HBV-related liver diseases(OR=5.576,95%CI2.137-14.552,P=0.000)as risk factors for HCMV infection in the first 90 days post-LT.The cumulative incidence of early HCMV infection post-LT was significantly higher in the non-HBV-related liver diseases group(P=0.001).In the non-HBV-related liver diseases recipients,early HCMV infection post-LT was correlated with the status of pre-transplant HBs Ab(P=0.006)and different degrees of anti-HBs titers were related to HCMV infection post-LT(P = 0.011).Among all LT recipients,the pre-transplant HBs Ag(P = 0.011)and HBc Ab(P = 0.001)serological status were associated with HCMV infection post-LT.HBV markers post-LT had no effect on HCMV infection.Conclusions:HCMV was still a common opportunistic infection within 90 days post-transplant and reducing ICU hospital stay or fungal infection may help reduce early HCMV infection post-transplant.More attention should be paid to increasing anti-HBs titers pre-transplant and may help reduce early HCMV infection in patients with non-HBV-related liver diseases.Pre-transplant anti-HBc negative recipients were more likely to develop early HCMV infection post-LT.