What is the most common viral infection associated with liver transplantation?

Updated: Dec 31, 2017
  • Author: Lemi Luu, MD, RDMS, FACEP, FAAEM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Cytomegalovirus (CMV) is the most common viral infection, occurring most commonly between posttransplant months 1 and 3. CMV is a herpes virus and infects between 25 and 85% of all liver transplant patients. CMV infection is rarely fatal unless disseminated and has little effect on the graft itself. The viral infection may be primary or reactivated.

Patients with CMV infection often present with fevers, malaise, arthralgias, atypical lymphocytes, thrombocytopenia, and mildly elevated transaminase levels. CMV pneumonitis often results in radiographic findings of bilateral infiltrates. Diagnosis is made serologically using an indirect immunofluorescence testing method. Treatment is effective when a diagnosis is made early, and ganciclovir is administered intravenously for 2-4 weeks.

Pneumocystis carinii pneumonia (PCP) may present with CMV infection or alone. Diagnosis sometimes requires a bronchoalveolar biopsy. Transplant recipients may be placed on long-term pneumocystic suppression therapy with trimethoprim-sulfamethoxazole. However, this infection is typically a problem when immunosuppression is more severe, such as during treatment of rejection.

When recipients are on increased immunosuppression therapy for additional induction or combating rejection, other less-common opportunistic pathogens may be involved. These include fungi (especially Candida species), herpes simplex, herpes zoster, P carinii, and Toxoplasma. Graft reinfection with hepatitis C virus (HCV) is very common, occurring in 50-80% of patients. Many of these patients will require treatment for HCV to avoid progression to cirrhosis. However, recurrent hepatitis B infection is less common (occurring in only 10% of patients) due to the prophylactic hepatitis B immunoglobulin and antiviral medications.

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