Published online Dec 16, 2021. doi: 10.12998/wjcc.v9.i35.10792
Peer-review started: May 13, 2021
First decision: July 4, 2021
Revised: July 17, 2021
Accepted: September 14, 2021
Article in press: September 14, 2021
Published online: December 16, 2021
Processing time: 210 Days and 21.1 Hours
Cytomegalovirus (CMV) infection is common in liver transplant (LT)_ recipients, and biliary complications occur in a large number of patients. It has been reported that CMV-DNA is more detectable in bile than in blood.
To investigate the effects of CMV infection on biliary complications by comparing the levels of CMV-DNA in the bile and blood of patients after LT.
We conducted a retrospective analysis of 57 patients who underwent LT, 10 of these patients had no biliary complications and 47 patients had biliary complications. We also compared the levels of CMV-DNA in patients’ bile and blood, which were sampled concurrently. We used RNAscope technology to identify CMV in paraffin-embedded liver sections.
CMV-DNA was not detected in bile samples and was detected in 2 blood samples from patients without biliary complications. In the 47 patients with biliary complications, CMV-DNA was detected in 22 bile samples and 8 blood samples, both bile and blood samples were positive for CMV-DNA in 6 patients. The identification rate of CMV-DNA in blood was 17.0%, and was 46.8% in bile. Moreover, tissue samples from 4 patients with biliary complications tested positive using RNAscope technology but were negative with hematoxylin and eosin staining. During the follow-up period, graft failure occurred in 13 patients with biliary complications, 8 of whom underwent retransplantation, and 3 died. CMV-DNA in bile was detected in 9 of 13 patients with graft failure.
In patients with biliary complications, the identification rate of CMV-DNA in bile was higher than that in blood. Blood CMV-DNA negative patients with biliary complications should still be monitored for CMV-related biliary tract diseases. Potential occult CMV infection may also be a contributing etiological factor in the development of graft failure.
Core Tip: For patients with biliary complications after liver transplantation, the clinical doctors should be alert to cytomegalovirus (CMV)-related biliary tract diseases even though the test of CMV-DNA in the blood is negative. The test for CMV-DNA in bile may be a novel approach for diagnosing occult CMV-related biliary disease. There has been no study on diagnosing CMV-related biliary complications after liver transplant by detecting CMV-DNA in isolated bile. Occult CMV infection in the biliary tract may be associated with biliary stenosis and a contributing factor to graft failure, leading to high mortality after surgery.