Relationship between Cytomegalovirus and Hepatic Function Abnormalities in the Period after Renal Transplant

Abstract

Forty-five consecutive recipients of renal transplants have been studied for three to 18 months (average time, 9.5 months). Sera were collected before transplant and at one, two, three, six, nine, 12, 15, and 18 months and tested for complement fixation antibody against cytomegalovirus (CMV) and herpes simplex virus type 1 (HSV1 ) . Before transplantation 34.3% had CMV titers ⩾1:4, while the comparable figure for HSV₁ was 42.9%. After transplantation 72.7% had fourfold or greater rises in CMV titer, while only 18.2% had such rises to HSVl Twenty of 44 patients (45.4%) developed chemical evidence of hepatitis following transplantation. Nine of the 20 had hepatitis B antigen-positive hepatitis. Nine of the remaining 11 patients had onset of hepatitis when they were undergoing CMV seroconversion. The attack rate of hepatitis B antigen-negative hepatitis was higher in persons who had greater maximal rises in antibody titer to CMV. Thirteen of the 20 cases, including five associated temporally with CMV seroconversion, had evidence of continuing hepatic dysfunction at and beyond 120 days. The study indicates comparability of initial prevalence of antibody to CMV and HSV₁ despite transfusion of an average of 7.7 units per person (predominantly leukocyte-poor blood) within three months of transplant. CMV may be an important cause of hepatic function abnormalities after renal transplant, and some of the changes induced may be chronic.