As in other transplantation settings, reactivation disease with herpes-group viruses is common (Table 126-3). Herpesviruses can be transmitted in donor organs. Although CMV hepatitis occurs in ~4% of liver transplant recipients, it is usually not so severe as to require retransplantation. Without prophylaxis, CMV disease develops in the majority of seronegative recipients of organs from CMVpositive donors, but fatality rates are lower among liver transplant recipients than among lung or heart-lung transplant recipients. Disease due to CMV can also be associated with the vanishing bile duct syndrome after liver transplantation. Patients respond to treatment with ganciclovir; prophylaxis with oral.
