Impact of cytomegalovirus infection on biliary disease after liver transplantation - maybe an essential factor

Table 1 Demographics and clinical characteristics comparisons by biliary complications

	Patients with biliary complications (n = 47)	Patients without biliary complications (n = 10)	P value
Age (yr)	33.0 (3.3-51.8)	51.6 (40.6-54.5)	0.021
Sex (M/F)	30/17	10/0	0.059
Primary disease (child)			/
Biliary atresia	11	0
Metabolic disease	6	0
Other	2	0
PELD	16.7 ± 13.5	/	/
Primary disease (adult)
Liver failure	3	0
Decompensated liver cirrhosis	14	10
HCC	9	0
Other	2	0
MELD	14.4 ± 6.3	15 ± 5.5	0.533
Liver transplantation			0.056
LDLT	10	0
DDLT	34	10
Cross-assisted liver transplantation	3	0	0.016
Cold ischemia time (min)	361.9 ± 244.4	582.1 ± 150.9
Warm ischemia time (min)	5 (3-5)	5 (5-7)	0.025
Biliary reconstruction (Duct-to-duct / Roux-en-Y)	23/9	1/9	0.404
Blood CMV status (P/N)	8/39	8/2	0.822
Biliary CMV status (P/N)	22/25	0/10	0.016
Rejection (Yes/No)	29/4	9/1	0.855
HAT (Yes/No)	1/32	0/10	0.578
Biliary drainage			1
PTCD	30	0
ENBD	12	0
T-tube	5	10
Outcome (alive/died)	39/8	10/0	0.365

HCC: Hepatocellular carcinoma; LDLT: Living donor liver transplantation; DDLT: Deceased donor liver transplantation; CMV: Cytomegalovirus; HAT: Hepatic artery thrombosis; PTCD: Percutaneous transhepatic cholangial drainage; ENBD: endoscopic nasobiliary drainage; PELD: Pediatric end-stage liver disease; MELD: Model for end-stage liver disease; M: Male; F: Female; P: Positive; N: Negative.

Table 2 Demographics and clinical characteristics comparisons by biliary complications in adults

	Patients with biliary complications (n = 28)	Patients without biliary complications (n = 10)	P value
Age (yr)	49.3 (37.8-57.5)	51.6 (40.6-54.5)	0.619
Sex (M/F)	19/9	10/0	0.079
Primary disease (adult)			0.047
Liver failure	3	0
Decompensated liver cirrhosis	14	10
HCC	9	0
Other	2	0
MELD	14.6 ± 6.8	15 ± 5.5	0.63
Liver transplantation			1
LDLT	1	0
DDLT	25	10
Cross-assisted liver transplantation	2	0
Cold ischemia time (min)	477.9 ± 193.7	582.1 ± 150.9	0.208
Warm ischemia time (min)	5 (3.25-5)	5 (5-7)	0.069
Biliary reconstruction (Duct-to-duct/Roux-en-Y)	16/2	9/1	0.927
Blood CMV status (P/N)	6/22	2/8	1
Biliary CMV status (P/N)	10/18	0/10	0.038
Rejection (Yes/No)	3/16	1/9	0.667
HAT (Yes/No)	1/18	0/10	0.46
Outcome (alive/died)	25/3	10/0	0.552

HCC: Hepatocellular carcinoma; LDLT: Living donor liver transplantation; DDLT: Deceased donor liver transplantation; CMV: Cytomegalovirus; HAT: Hepatic artery thrombosis; MELD: Model for end-stage liver disease; M: Male; F: Female; P: Positive; N: Negative.

Table 3 Demographics and clinical parameter comparisons by biliary cytomegalovirus status in patients with biliary complications

Biliary cytomegalovirus status	Children with biliary complications		P value	Adults with biliary complications		P value
	Positive (n = 12)	Negative (n = 7)		Positive (n = 10)	Negative (n = 18)
Age	25.8 (7.9-126.3) mo	9.0 (6.0-94.1) mo	0.612	51.6 ± 8.3 yr	44.7 ± 14.5 yr	0.250
Sex (M/F)	6/6	5/2	0.667	7/3	12/6	0.856
Primary disease (child)			0.414			/
Biliary atresia	7	4		/	/
Metabolic disease	4	2		/	/
Other	1	1		/	/
Primary disease (adult)			/			0.487
Liver failure	/	/		1	2
Decompensated liver cirrhosis	/	/		4	10
HCC	/	/		5	4
Other	/	/		0	2
Liver transplantation			0.351			0.241
LDLT	6	3		0	1
DDLT	6	3		10	15
Cross-assisted liver transplantation	0	1		0	2
Cold ischemia time (min)	169 (57.5-547.5)	94 (55.5-296)	0.429	445.5 (195.5-583.8)	490.0 (402.5-672.5)	0.604
Warm ischemia time (min)	3 (3-6)	3.5 (1.5-5.5)	0.788	5	5 (2-5)	0.145
Biliary reconstruction (Duct-to-duct/Roux-en-Y)	4/3	3/4	0.710	6/0	10/2	0.529
Laboratory parameters before bile drainage
Bilirubin (mol/L)	100.4 (35.2-390.8)	14.9 (9.5-36.9)	0.009	91.0 (35.9-203.0)	37.0 (24.1-97.9)	0.150
AST (U/L)	287.1 (58.2-635.0)	66.1 (54.3-123.0)	0.118	115.2 (69.2-189.8)	66.1 (36.5-146.4)	0.292
ALT (U/L)	106.0 (71.8-445.8)	79.0 (44.0-98.0)	0.205	117.0 (71.5-151.5)	60.5 (39.0-183.0)	0.502
ALP (U/L)	702.0 (177.0-1096.8)	256.0 (183.0-968.0)	0.735	368.0 (168.8-908.0)	388.5 (199.5-628.25)	0.943
GGT (U/L)	469.5 (388.25-847.25)	478.0 (206.0-1206.0)	0.866	334.5 (160.5-731.5)	289.5 (229.5-492.5)	0.811
Bac Inf. (biliary tract) (P/N)	9/3	5/2	0.865	4/4	9/3	0.503
Biliary stricture (P/N)	12/0	5/2	0.237	9/1	18/0	0.761
Rejection (Yes/No)	1/7	0/6	0.755	2/5	1/11	0.523
HAT (Yes/No)	0/8	0/6	1.000	0/7	1/11	1.000
Outcome (Alive/Died)	9/3	5/2	0.865	8/2	17/1	0.585

ERCP: Endoscopic retrograde cholangiopancreatography; PTCD: Percutaneous transhepatic cholangial drainage; AST: Aspartate aminotransferase; ALT: Alanine transaminase; ALP: Alkaline phosphatase; GGT: Gamma glutamyl transferase; CRP: C-reactive protein; HCC: Hepatocellular carcinoma; LDLT: Living donor liver transplantation; DDLT: Deceased donor liver transplantation; Bac Inf.: Bacterial infection; HAT: Hepatic artery thrombosis; M: Male; F: Female; P: Positive; N: Negative.

Table 4 Comparison of biliary complications and bile cytomegalovirus-DNA

		Biliary complications		Total
		Anastomotic stricture	Non-anastomotic stricture
Bile cytomegalovirus-DNA	Positive	14	8	22
	Negative	7	18	25
Total		21	26	47

Table 5 Comparison of biliary and blood cytomegalovirus-DNA in patients with biliary complications

		Biliary CMV-DNA		Total
		Positive	Negative
Blood cytomegalovirus-DNA	Positive	6	2	8
	Negative	16	23	39
Total		22	25	47