Relationship between cytomegalovirus and hepatic function abnormalities in the period after renal transplant

Forty five consecutive recipients of renal transplants have been studied for 3 to 18 mth (average time, 9.5 mth). Sera were collected before transplant and at 1,2,3,6,9,12,15 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 four fold or greater rises in CMV titer, while only 18.2% had such rises to HSV₁. 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 5 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 3 mth of transplant. CMV may be an important cause of hepatic function abnormalities after renal transplant, and some of the changes induced may be chronic. (25 references).