The frequency of CMV and EBV infections before liver transplantation in patients on the waiting list for liver transplantation referring to a liver transplant center, the North of Iran

Reihaneh Sadeghi Garmaroodi, Hamed Naziri, Pirooz Samidoust


Viral infections, such as cytomegalovirus (CMV) and Epstein-Barr virus (EBV), contribute to the low survival rates of liver transplant patients. This study aimed to assess the prevalence of CMV and EBV infections in patients awaiting liver transplantation. Utilizing a census sampling approach, this cross-sectional study examined all cases of viral infections from 2016 to 2021 among liver transplant patients referred to Rasht liver transplant center, the North of Iran. In total, 34 individuals with a mean age of 48.9±12.2 years were included in the study. Of these, 40 individuals (59.7%) were male. The prevalence of CMV IgM and IgG antibodies among liver transplant candidates was 7.5%, and 97%, respectively. Also, the prevalence of EBV IgM and IgG antibodies was 7.5%, and 97%, respectively. The average serum vitamin D level in CMV IgM-negative patients was 30.7±17.2 compared to 55.1±22.1 in CMV IgM-positive patients (p = 0.011). The prevalence of CMV and EBV infections in liver transplant patients was found to be 7.5%. These results highlight the necessity for continuous and effective strategies to prevent infection-related complications through prompt diagnosis and treatment, which are crucial for positive liver transplant outcomes.


Cytomegalovirus; Epstein-Barr virus; Liver transplantation; Transplant recipient; Transplant donor

Full Text:

Full-text PDF


Moreno R, Berenguer M. Post-liver transplantation medical complications. Ann Hepatol. 2006;5(2):77–85.

Dharnidharka VR, Stablein DM, Harmon WE. Post‐Transplant Infections Now Exceed Acute Rejection as Cause for Hospitalization: A Report of the NAPRTCS 1. Am J Transplant. 2004;4(3):384–9.

Bowden RA, Ljungman P, Snydman DR. Transplant infections. Lippincott Williams & Wilkins; 2012.

Murray KF, Carithers Jr RL. AASLD practice guidelines: evaluation of the patient for liver transplantation. Hepatology. 2005;41(6):1407–32.

Freeman Jr RB, Wiesner RH, Harper A, McDiarmid S V, Lake J, Edwards E, et al. The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transplant. 2002;8(9):851–8.

Lucey MR, Brown KA, Everson GT, Fung JJ, Gish R, Keeffe EB, et al. Minimal criteria for placement of adults on the liver transplant waiting list: a report of a national conference organized by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases. Liver Transplant Surg. 1997;3(6):628–37.

Wiesner RH, McDiarmid S V, Kamath PS, Edwards EB, Malinchoc M, Kremers WK, et al. MELD and PELD: application of survival models to liver allocation. Liver Transplant. 2001;7(7):567–80.

Cholongitas E, Papatheodoridis G V, Vangeli M, Terreni N, Patch D, Burroughs AK. Systematic review: the model for end‐stage liver disease–should it replace Child‐Pugh’s classification for assessing prognosis in cirrhosis? Aliment Pharmacol Ther. 2005;22(11‐12):1079–89.

Rana A, Hardy MA, Halazun KJ, Woodland DC, Ratner LE, Samstein B, et al. Survival outcomes following liver transplantation (SOFT) score: a novel method to predict patient survival following liver transplantation. Am J Transplant. 2008;8(12):2537–46.

Alexander J, Limaye AP, Ko CW, Bronner MP, Kowdley K V. Association of hepatic iron overload with invasive fungal infection in liver transplant recipients. Liver Transplant. 2006;12(12):1799–804.

Chow JK, Werner BG, Ruthazer R, Snydman DR. Increased serum iron levels and infectious complications after liver transplantation. Clin Infect Dis. 2010;51(3):e16–23.

Rubin RH. Cytomegalovirus in solid organ transplantation. Transpl Infect Dis. 2001;3(4):1–5.

Falagas ME, Snydman DR. Recurrent cytomegalovirus disease in solid-organ transplant recipients. In: Transplantation proceedings. 1995. p. 34–7.

Fishman JA, Rubin RH. Infection in organ-transplant recipients. N Engl J Med. 1998;338(24):1741–51.

Tolk O RR. Viral infections in organ transplantation. 1998;10(1):1060–3.

Mandell B, Bennett JE, R D Mandell B. Dolin: Principles and Practice of Infectious Diseases. Churchill Livingstone An Impr Elsevier Copyr 2005. 2005;4(2):1864–90.

Borchers AT, Perez R, Kaysen G, Ansari AA, Gershwin ME. Role of cytomegalovirus infection in allograft rejection: a review of possible mechanisms. Transpl Immunol. 1999;7(2):75–82.

Schroeder R, Michelon T, Fagundes I, Bortolotto A, Lammerhirt E, Oliveira J, et al. Cytomegalovirus disease latent and active infection rates during the first trimester after kidney transplantation. In: Transplantation proceedings. Elsevier; 2004. p. 896–8.

Sagedal S, Nordal KP, Hartmann A, Sund S, Scott H, Degré M, et al. The impact of cytomegalovirus infection and disease on rejection episodes in renal allograft recipients. Am J Transplant. 2002;2(9):850–6.

ter Meulen CG, Wetzels JFM, Hilbrands LB. The influence of mycophenolate mofetil on the incidence and severity of primary cytomegalovirus infections and disease after renal transplantation. Nephrol Dial Transplant. 2000;15(5):711–4.

Schnitzler MA, Lowell JA, Hmiel SP, Hardinger KL, Liapis H, Ceriotti CS, et al. Cytomegalovirus disease after prophylaxis with oral ganciclovir in renal transplantation: the importance of HLA-DR matching. J Am Soc Nephrol. 2003;14(3):780–5.

Rostaing L, Wéclawiak H, Mengelle C, Kamar N. Viral infections after kidney transplantation. Minerva Urol e Nefrol Ital J Urol Nephrol. 2011;63(1):59–71.

Khorvash F. Cytomegalovirus Infection in Renal Recipients in Al_Zahra Hospital of Isfahan. J Jahrom Univ Med Sci. 2007;5(3):15–21.

Kenagy DN, Schlesinger Y, Weck K, Ritter JH, Gaudreault-Keener MM, Storch GA. Epstein-Barr virus DNA in peripheral blood leukocytes of patients with posttransplant lymphoproliferative disease. Transplantation. 1995;60(6):547–54.

Acott PD, Lee SHS, Bitter-Suermann H, Lawen JG, Crocker JFS. Infection concomitant with pediatric renal allograft rejection. Transplantation. 1996;62(5):689–91.

Shahinian VB, Muirhead N, Jevnikar AM, Leckie SH, Khakhar AK, Luke PP, et al. Epstein-Barr virus seronegativity is a risk factor for late-onset posttransplant lymphoroliferative disorder in adult renal allograft recipients1. Transplantation. 2003;75(6):851–6.

Jamalidoust M, Namayandeh M, Pouladfar G, Ziyaeyan M. Post-Liver Transplant Cytomegalovirus (CMV) Reactivation, Graft, and Patient Survival Rates in Iranian Population. Jundishapur J Microbiol. 2021;14(3).

Fernández-García OA, García-Juárez I, Belaunzarán-Zamudio PF, Vilatoba M, Wisniowski-Yáñez A, Salomón-Ávila J, et al. Incidence of Cytomegalovirus disease and viral replication kinetics in seropositive liver transplant recipients managed under preemptive therapy in a tertiary-care center in Mexico City: a retrospective cohort study. BMC Infect Dis. 2022;22(1):1–7.

Varghese J, Subramanian S, Reddy MS, Shanmugam N, Balajee G, Srinivasan V, et al. Seroprevalence of cytomegalovirus in donors & opportunistic viral infections in liver transplant recipients. Indian J Med Res. 2017;145(4):558–60.

Dehghani M, kasiri K, mohamadi J hasan pour K. Prevalence of Cytomegalovirus Infection in Candidates for Pediatric Liver Transplantation at Namazi Hospital of Shiraz During 2006-2009. sjimu. 2013;21(6):125-133.

Lizaola-Mayo BC, Rodriguez EA. Cytomegalovirus infection after liver transplantation. World J Transplant. 2020;10(7):183.

Gane E, Saliba F, Valdecasas GJC, O’Grady J, Pescovitz MD, Lyman S, et al. Randomised trial of efficacy and safety of oral ganciclovir in the prevention of cytomegalovirus disease in liver-transplant recipients. Lancet. 1997;350(9093):1729–33.

Abdullatif H, Dhawan A, Verma A. Epidemiology and Risk Factors for Viral Infections in Pediatric Liver Transplant Recipients and Impact on Outcome. Viruses. 2023;15(5):1059.

Halliday N, Smith C, Atkinson C, O’Beirne J, Patch D, Burroughs AK, et al. Characteristics of Epstein–Barr viraemia in adult liver transplant patients: A retrospective cohort study. Transpl Int. 2014;27(8):838–46.

KH M, SH Salari L. Prevalence of Epstein BARR virus infection and effecting factors in renal allograft recipients for controlling PTLD in imam khomeini hospital from 2001 to 2004. J Shaheed Sadoughi Univ Med Sci Heal Serv. 2007;15(3):53–60.

Rieder FJJ, Gröschel C, Kastner M-T, Kosulin K, Laengle J, Zadnikar R, et al. Human cytomegalovirus infection downregulates vitamin-D receptor in mammalian cells. J Steroid Biochem Mol Biol. 2017;165:356–62.

Beanrde A, Van Winden K, Frederick T, Kono N, Operskalski E, Pandian R, et al. Low maternal vitamin D is associated with increased risk of congenital and peri/postnatal transmission of Cytomegalovirus in women with HIV. PLoS One. 2020;15(2):e0228900.

Shirafkan H, Yazdani Charati J, Mozaffarpur SA, Khafri S, Akbari R, Oliaei F. Evaluation of Influential Factors in the Incidence Period of Cytomegalovirus after Renal Transplantation. J Babol Univ Med Sci. 2016;18(4):41–7.


  • There are currently no refbacks.

Copyright (c) 2024 Hamed Naziri

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.