ARMS as a Genotyping PCR, a New Technique for Detection of Liver Transplantation Recipients’ C3FF, C3FS, C3SS Allotypes as Predisposing Factor For Post-Transplantation Infections

Abstract

Background: Complement is a crucial branch of both non-specific and specific immune\nsystem. C3 is the third complement component which plays a protective role in viral\ninfections. There are two co-dominant inherited variants or allotypes for C3: C3 fast\n(C3F) and C3 slow (C3S). C3F variant has been linked to multiple diseases production\nincluding infections among liver transplantation recipients. Objectives: To investigate\nthe most common risk factors for post-liver transplantation infections especially preoperative colonization. To identify types and rates of post-liver transplantation infections\nand their causing organisms. To identify C3 allotypes for both liver transplantation\ndonors and recipients, and to correlate recipients’ allotypes with post-transplantation\ninfections. Methodology: This study is a prospective study; it was conducted from\nJanuary 2017 to August 2019 on 64 chronic cirrhotic patients, experienced liver\ntransplantation in the National Liver Institute ICU, Menoufia, Egypt, and their donors.\nBlood cultures and other samples were collected according to site of infection using\nstandard Microbiological sample collection methods and bacterial isolated were\nidentified by standard microbiological methods using VITEK2 Compact automated\nID/AST instrument. CMV IgG and IgM were detected by ELISA method. DNA was\nextracted and the extract was used for detection of C3S and C3F alleles by using\nAmplification Refractory Mutation System (ARMS). Results: The most common cause for\nliver transplantation was HCV related liver cirrhosis (26.56%). Risk factors for postliver transplantation were Pre-operative microbial colonization (100%) and long\noperative time (9.875±2.45 h). 39.8% of post-transplantation infections occurred during\nsecond week post-operatively and the commonest infections were drain infections\n(29.5%) and urinary tract infection (27.3%). 51.7% of liver transplantation recipients\nwere C3FF, 32.8% were C3FS and 15.6% were C3SS. C3FF recipients showed\nincreased relative risk to develop CMV (5.2) and bacterial & fungal infections (2.2) than\nother recipients’ allotypes. Conclusion: A comprehensive infectious diseases workup\nincluding detection of C3 allotype of the candidate for liver transplantation should be\ndone pre-operatively to early detect and treat infections which can improve the outcome\nof the operation dramatically and improve patients’ life style. More studies should be\ndone to find out if there is relation between donors’ and recipients’ C3 allotypes as\ncurrently no clear data still present.