Jundishapur J Microbiol. 2021 March; 14(3):e112775. Published online 2021 June 7. doi: 10.5812/jjm.112775. Research Article Post-Liver Transplant Cytomegalovirus (CMV) Reactivation, Graft, and Patient Survival Rates in Iranian Population Marzieh Jamalidoust 1, * , Mandana Namayandeh 1 , Gholamreza Pouladfar 1 and Mazyar Ziyaeyan 1 1 Professor Alborzi Clinical Microbiology Research Center, Nemazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran * Corresponding author: Professor Alborzi Clinical Microbiology Research Center, Nemazi Hospital, Shiraz University of Medical Sciences, P.O. Box: 71937-11351, Shiraz, Iran. Tel: +98-7116474304, Fax: +98-7116474303, Email: mjamalidoust@gmail.com Received 2021 January 23; Revised 2021 May 09; Accepted 2021 May 10. Abstract Background: Human cytomegalovirus (CMV) is the major complication of viral infection in immunocompromised patients. This opportunistic infection is associated with high morbidity and mortality in transplanted recipients. Objectives: The present study aimed to determine CMV burden and assess the clinical outcome in the liver recipients with CMV reactivated infection at Nemazi Hospital, Shiraz, Iran. Methods: This retrospective study examined 657 patients who underwent liver transplantation during 2014 - 2017 to identify the CMV infection, morbidity, and mortality rates. To this end, the medical records of such patients were reviewed, and their rejec- tion/survival rates were analyzed. Accordingly, the CMV infection was diagnosed by Taq-Man real-time PCR assays. Results: In this study, 151 (23%) had CMV reactivation at least one year after liver transplantation. Viremic patients had a viral burden between 300 - 738790 copies/mL. In this study, 41 persons (6.2%) died, and 58 liver transplant patients (8.8%) had rejection experi- ence up to one year after their operation. Among the 41 dead patients, 21 and 20 cases were with and without CMV-reactivation, respectively. The results demonstrated that the mortality rate was significantly higher in the CMV-infected patients than the non- CMV-infected counterparts. In contrast, the graft survival rate was not significantly different between the two groups (P ≤ 0.05). Conclusions: In the present study, CMV infection can serve as a significant mortality predictor in LT patients. Keywords: Cytomegalovirus, Liver/Transplantation, Quantitative PCR Assay, Survival Rate, Infection, CMV Disease 1. Background Human cytomegalovirus (CMV) is a ubiquitous virus from the Herpesviridea family, β-herpesvirinea subfamily, alternatively known as HHV5 (Human herpes virus-5) (1, 2). Human cytomegalovirus infection is a life-threatening in- fection in immunocompromised patients, especially HIV sufferers and organ transplant recipients (3, 4). Despite much advancement in controlling CMV infection since the first successful liver transplantation in 1967, the virus had remained as the most important pathogen influenc- ing the outcome of liver transplantation (5, 6). Human cytomegalovirus infection can significantly increase mor- bidity and mortality rates among transplant patients. De- pending on interrelated factors such as donor and recip- ient match, serological status, immunosuppressive drug regimes, the overall functionality of innate/acquired im- munity system, and CMV viral factors, the incidence of CMV infection in such patients varies (6, 7). It is estimated that 16-47% of all liver transplant patients develop CMV diseases (6). Universal prophylaxis and preemptive therapy are the primary approaches to preventing direct and indirect ad- verse CMV effects as well as associated diseases induced by liver transplantation (8). In this regard, antiviral prophy- laxis is more preferred (9, 10). Development of CMV dis- eases in patients without antiviral prophylaxis is expected during the first three months after transplantation. There is a delay in the onset of CMV diseases in those on prophy- laxis drugs, with lower frequencies (10). In the recent decade, newly developed diagnostic vi- rological methods have improved CMV infection manage- ment in LT patients. Cytomegalovirus nucleic acid amplifi- cation tests, especially Taq-man real-time PCR assay, are sus- ceptible and rapid tests utilized for the CMV disease prog- nosis, the evaluation of the CMV treatment efficacy, and preemptive therapy (11). Antigenemia is another CMV diag- nostic test in the post-transplant operation period, which detects pp65 in the blood leukocytes. However, this partic- ular test cannot be routinely used for neutropenic LT pa- tients and cannot be applied to other body fluids of the sufferers as well (12, 13). Serology tests may be significant Copyright © 2021, Author(s). 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