الفهرس 
liver transplantationOnly 14 pages are availabe for public view
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Abstract
Viral infections are common after liver transplantation in the form of nosocomial infections, opportunistic infections due to the immunocompromized state of patients occur during the first 6 months after liver transplantation. CMV infection is the most frequent viral infection after LT is associated with higher risks of other opportunistic infections, graft loss and higher mortality.
CMV serology to detect IgG, IgM has a limited role for diagnosis in post-liver transplant recipients, but defines the serostatus of patients before transplantation
HHV-6 can cause primary infection or reactivation from latency in liver transplant recipients. HHV-6 is a ubiquitous virus that typically causes primary infection in children, most commonly before the age of 2 years. Since over 95% of humans are infected, the vast majority of active HHV-6 infections detected in adults are thought to be the cause of the reactivation of endogenous latent HHV-6.
Multiplex PCR assay was developed to quickly and simultaneously detect many types of viral DNA genomes, including eight herpes family viruses, from various samples such as blood,ocular fluid, CSF,urine, bronchoalveolar lavage fluid and gastrointestinal mucosa.
Multiplex PCR assays have many advantages compared to singleplex assays. For example, with multiplexing, test costs are reduced; turnaround times are improved with increasing the test throughput. These benefits have a positive effect on clinical service, allowing clinicians to tailor patient management or to begin antiviral therapy more quickly. But these assays need careful optimization to avoid competition and maintain sensitivity when more than one pathogen is present in the patient sample.
This cohort prospective study aimed to evaluate the incidence of CMV and HHV-6 by multiplex PCR after liver transplantation. It included 20 apparently healthy controls and 40 patients. CMV and HHV-6 were measured by multiplex PCR before transplantation, one month, and 3 months after transplantation.
In this study, the serostatus of CMV before liver transplantation was revealed as all the recipients were positive (R+) and all the donors also positive were (D+), so this group was in the intermediate risk. Meanwhile, after 3 months of liver transplantation: CMV multiplex PCR analysis showed no positive cases in donors while the recipients presented six positive cases with an incidence rate of 15%. For HHV-6 multiplex PCR, the results showed two positive cases in the recipients, one of them also had a positive result for CMV PCRwith an incidence rate of 5%.
In the present study, the assay of laboratory tests at three months after transplantation indicated an obvious elevation in liver enzymes.The changes in laboratory parameters (difference between after-before transplantation) were compared between CMV positive and CMV negative PCR in the recipients group, a high significant difference between them regarding changes in ALT, AST, ALP, and GGT (P<0.01) were observed as the enzyme activities were decreased in negative CMV PCR while increased in the positive CMV PCR.
In this study, no cases were reported with transplant rejection at the follow-up time of three months. chronic allograft liver transplantationrejection develops slowly over a period of months or years and is the main cause of late graft loss. The onset is usually within several months after transplantation. chronic allograft liver transplantationrejection was associated with persistent cytomegalovirus replication.
This study supported the utility of multiplex real-time PCR of CMV and HHV-6 detection for follow-up and management of liver transplanted recipients considering the technique benefits in saving time and labor.