Association of cytomegalovirus genotype with graft rejection after liver transplantation

Hugo R. Rosen, Christopher Corless, John Rabkin, Sunwen Chou

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Background. The envelope glycoprotein gB of human cytomegalovirus (CMV) occurs as one of four main genotypes. Some previous studies have proposed a relationship of CMV gB genotype to the frequency of symptomatic infection and to clinical outcomes in both transplant and human immunodeficiency virus- infected populations. Our aim was to define the distribution of CMV gB genotypes and the impact on acute cellular rejection and graft/patient survival after orthotopic liver transplantation (OLT). Methods. Between October 1988 and December 1996, 325 patients underwent cyclosporine-based OLT at our center. CMV infection was surveyed prospectively and defined as viral isolation from blood or urine; 53 (16%) patients had detectable CMV. Isolates were genotyped by polymerase chain reaction amplification and restriction digest analysis. Results. The distribution of CMV genotypes was: gB1, 19 (36%) patients; gB2, 15 (28%) patients; gB3, 13 (24%) patients; and gB4, 4 (8%) patients. Two patients (4%) had mixed infection (1 + 3, 1 + 4). Age, preOLT diagnosis, use of ganciclovir prophylaxis, basal immunosuppression, mean number of HLA donor/recipient mismatches, and United Network of Organ Sharing status were comparable among patients with different genotypes. Patients with gB1 had a significantly higher mean number of acute rejection episodes (1.52±0.30 vs. 0.67±0.22; P=0,027). However, there was no difference in rejection severity, including OKT3 usage or FK506 conversion, or development of chronic rejection among patients with different genotypes. The gB genotype did not affect the development of symptomatic or tissue- invasive CMV disease, detected in 15 patients. Actuarial rates of patient (odds ratio [OR] 3.0; confidence interval [CI] 1.49-6.0) and graft (OR 2.57; CI 1.25-5.22) survival were significantly diminished in the group with CMV infection versus those without CMV (P

Original languageEnglish (US)
Pages (from-to)1627-1631
Number of pages5
JournalTransplantation
Volume66
Issue number12
DOIs
StatePublished - Dec 27 1998

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Graft Rejection
Cytomegalovirus
Liver Transplantation
Genotype
Cytomegalovirus Infections
Odds Ratio
Confidence Intervals
Transplants
Muromonab-CD3
Ganciclovir
Tacrolimus
Graft Survival
Coinfection
Immunosuppression
Cyclosporine
Glycoproteins
Tissue Donors
HIV
Urine

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Association of cytomegalovirus genotype with graft rejection after liver transplantation. / Rosen, Hugo R.; Corless, Christopher; Rabkin, John; Chou, Sunwen.

In: Transplantation, Vol. 66, No. 12, 27.12.1998, p. 1627-1631.

Research output: Contribution to journalArticle

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abstract = "Background. The envelope glycoprotein gB of human cytomegalovirus (CMV) occurs as one of four main genotypes. Some previous studies have proposed a relationship of CMV gB genotype to the frequency of symptomatic infection and to clinical outcomes in both transplant and human immunodeficiency virus- infected populations. Our aim was to define the distribution of CMV gB genotypes and the impact on acute cellular rejection and graft/patient survival after orthotopic liver transplantation (OLT). Methods. Between October 1988 and December 1996, 325 patients underwent cyclosporine-based OLT at our center. CMV infection was surveyed prospectively and defined as viral isolation from blood or urine; 53 (16{\%}) patients had detectable CMV. Isolates were genotyped by polymerase chain reaction amplification and restriction digest analysis. Results. The distribution of CMV genotypes was: gB1, 19 (36{\%}) patients; gB2, 15 (28{\%}) patients; gB3, 13 (24{\%}) patients; and gB4, 4 (8{\%}) patients. Two patients (4{\%}) had mixed infection (1 + 3, 1 + 4). Age, preOLT diagnosis, use of ganciclovir prophylaxis, basal immunosuppression, mean number of HLA donor/recipient mismatches, and United Network of Organ Sharing status were comparable among patients with different genotypes. Patients with gB1 had a significantly higher mean number of acute rejection episodes (1.52±0.30 vs. 0.67±0.22; P=0,027). However, there was no difference in rejection severity, including OKT3 usage or FK506 conversion, or development of chronic rejection among patients with different genotypes. The gB genotype did not affect the development of symptomatic or tissue- invasive CMV disease, detected in 15 patients. Actuarial rates of patient (odds ratio [OR] 3.0; confidence interval [CI] 1.49-6.0) and graft (OR 2.57; CI 1.25-5.22) survival were significantly diminished in the group with CMV infection versus those without CMV (P",
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