Co-infections by EBV, CMV, and Helicobacter pylori are highly frequent in liver transplant recipients

The objectives of this observational study were to determine the frequency of multiple infections by Helicobacter pylori, Epstein-Barr virus (EBV), and human cytomegalovirus (HCMV) and to relate the infection by EBV and HCMV with H. pylori cagA genotypes in the lymph nodes in liver transplant recipients. A total of 43 HCV-positive liver-transplant patients were selected. They performed a history interview, physical, and biochemical examination. DNA was extracted from paraffin-embedded (enlarged perihepatic lymph node) tissue to detect H. pylori infection by polymerase chain reaction (PCR) targeting the UreA gene and the virulence gene. Additionally, Antibody screening assays on blood samples were used to look for antibodies against EBV and HCMV. In all, 53.5% patients showed H.pylori infection with UreA gene detection. Out of them, 8 (34.8%) were positive for the CagA virulence gene. Regarding CMV, 95.3% were CMV IgG-positive, and coinfection with H.pylori was detected in 56.9%. Regarding EBV, 79.7% were EBV IgG-positive, and coinfection with H.pylori was detected in 50.0%. Triple infection of EBV, HCMV, and H. pylori was detected in 41.9%. Significant differences were found between single infections or coinfections of H. pylori and its genotypes with EBV or HCMV infection. Because graft survival requires immunosuppression, co-infections with EBV, CMV, and H. pylori pose a serious risk to liver transplant recipients. To improve patient outcomes, it is essential to comprehend the risks and put the right management techniques into practice.