Cytomegalovirus hepatitis diagnosis optimization in liver transplant recipients: 10 years of experience

Abstract

Background: Cytomegalovirus (CMV) hepatitis constitutes a challenging diagnostic entity in liver transplant (LT) recipients. Aim:  To determine the real incidence of CMV hepatitis using more specific diagnostic tools as those currently used before. Methods: Retrospective/prospective study conducted in a hepatic transplant unit from 2009 to 2019. LT recipients with CMV specific or suggestive elements in histopathology of hepatic biopsies were included. Immunohistochemistry (IHQ) was performed in tissue samples of the studied cohort as well as in a control one. Results: 41 patients met the inclusion criteria. IHQ was diagnostic in 6 (14.6%), and was negative in 100% of the control population. The negative predictive value of the histopathology for CMV hepatitis diagnosis was 100% and the positive predictive value was 14.6%. 85% of patients in whom the IHQ was negative had alternative diagnosis Antiviral therapy in the retrospective analysis was indicated in 48% of patients and in 21% of the prospectively analyzed cohort. Conclusions:  Histopathology and IHQ combination improves the diagnostic accuracy of CMV hepatitis which translates into a rational us of expensive antiviral therapy and to search for differential diagnosis