Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Jun 26;8(12):2597-2602.
doi: 10.12998/wjcc.v8.i12.2597.

Novel approach for the diagnosis of occult cytomegalovirus cholangitis after pediatric liver transplantation: A case report

Ying Liu  1 , Li-Ying Sun  2 , Zhi-Jun Zhu  1 , Wei Qu  1
Affiliations
Case Reports

Novel approach for the diagnosis of occult cytomegalovirus cholangitis after pediatric liver transplantation: A case report

Ying Liu et al. World J Clin Cases. .

Abstract

Background: Cytomegalovirus (CMV) infection is a common infection in liver transplant recipients, which is related to chronic rejection and biliary complications. It is often diagnosed based on serum CMV-DNA or CMV pp65. To our knowledge, this is the first report of the successful treatment of occult CMV cholangitis in a pediatric liver transplantation (LT) recipient.

Case summary: A 7-mo-old baby girl received LT due to biliary atresia and cholestasis cirrhosis. At 1 mo following LT, the patient suffered from aggravated jaundice with no apparent cause. As imaging results showed intrahepatic and extrahepatic bile duct dilatation, the patient was diagnosed with biliary complications and percutaneous cholangiography and biliary drainage was performed. However, there was little biliary drainage and her liver function deteriorated. CMV-DNA was isolated from the bile with the surprising outcome that 3 × 106 copies/mL were present, whereas the CMV-DNA in serum was negative. Following antiviral therapy with ganciclovir, she gradually recovered and bilirubin decreased to normal levels. During the 4-year follow-up period, her liver function remained normal.

Conclusion: Bile CMV sampling can be used for the diagnosis of occult CMV infection, especially in patients with negative serum CMV-DNA and CMV pp65. Testing for CMV in the biliary tract may serve as a novel approach for the diagnosis of cholestasis post-LT. Timely diagnosis and treatment will decrease the risk of graft loss.

Keywords: Bile cytomegalovirus-DNA detection; Biliary complications; Case report; Liver transplantation; Occult cytomegalovirus cholangitis; Pediatric.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Biliary cholangiography showing biliary anastomotic stricture (arrow). Biliary drainage was completed after balloon dilatation on postoperative day 77.
Figure 2
Figure 2
Liver biopsy showing hydropic degeneration and cholestasis of the liver on postoperative day 93.
Figure 3
Figure 3
Changes in total bilirubin and direct bilirubin before and after treatment. PTCD: Percutaneous transhepatic cholangio drainage; TB: Total bilirubin; DB: Direct bilirubin; POD: Postoperative day.
Figure 4
Figure 4
Changes in alkaline phosphatase and gamma-glutamyl transpeptidase before and after treatment. PTCD: Percutaneous transhepatic cholangio drainage; ALP: Alkaline phosphatase; GGT: Gamma-glutamyl transpeptidase; POD: Postoperative day.
See this image and copyright information in PMC

References

    1. Dubbeld J, van Hoek B, Ringers J, Metselaar H, Kazemier G, van den Berg A, Porte RJ. Biliary complications after liver transplantation from donation after cardiac death donors: an analysis of risk factors and long-term outcome from a single center. Ann Surg. 2015;261:e64. - PubMed
    1. Nemes B, Gámán G, Doros A. Biliary complications after liver transplantation. Expert Rev Gastroenterol Hepatol. 2015;9:447–466. - PubMed
    1. Aberg F, Mäkisalo H, Höckerstedt K, Isoniemi H. Infectious complications more than 1 year after liver transplantation: a 3-decade nationwide experience. Am J Transplant. 2011;11:287–295. - PubMed
    1. Gotthardt DN, Senft J, Sauer P, Weiss KH, Flechtenmacher C, Eckerle I, Schaefer Y, Schirmacher P, Stremmel W, Schemmer P, Schnitzler P. Occult cytomegalovirus cholangitis as a potential cause of cholestatic complications after orthotopic liver transplantation? A study of cytomegalovirus DNA in bile. Liver Transpl. 2013;19:1142–1150. - PubMed
    1. Moy BT, Birk JW. A Review on the Management of Biliary Complications after Orthotopic Liver Transplantation. J Clin Transl Hepatol. 2019;7:61–71. - PMC - PubMed

Publication types