Chronic Rejection and CMV Infection in Patients Post Living Donor Liver Transplantation

Abstract

To assess the incidence of chronic rejection and CMV infection and their possible interrelation in patients post living donor liver transplantation. Patients and Methods: A Retrospective study that included 77 patients successfully survived living donor liver transplantation (LDLT) and passed more than 3 months post transplant. We did a retrospective study to determine the incidence of chronic rejection and the incidence of CMV infection and the possible relation between them. All cases of chronic rejection were proved by histpatological confirmation with at least 50% or more vanishing bile syndrome in addition to a confirming CMV PCR. Results: The 77 patients included in the study were mostly transplanted because of HCV related end stage liver disease age range from 21 to 62years (mean 49years).other indications included primary biliary cirrhosis, primary sclerosing cholangitis, HBV related end stage liver disease, in addition to those transplanted for hepatocellular carcinoma and auto-immune hepatitis. All transplanted patients and donors were CBD IgG +ve before transplant. The incidence of chronic rejection which was all in the HCV group was 4.62% (6 patients). Three (2.31%) patients had CMV infection, all during the first 5 months post transplant. In patients with chronic rejection; 2 (33.3%) patients had CMV infection, 3 (50%) patients were treated with PEG INF and 1 (16.7%) patient was not CMV infected nor treated with interferon and had no obvious predisposing factors. Conclusion: Conclusion: In our series of LDLT, the incidence of chronic rejection is 4.6% and the incidence of CMV infection is 2.3%. Among the important predisposing factors for chronic rejection is CMV infection which will mostly lead to chronic rejection and graft loss. Another possible factor is interferon therapy for HCV as the rate of chronic rejection in the group of patients treated with PEG INF was (13.3%).