Int J Infect Dis. 2026 Aug 18:109048. doi: 10.1016/j.ijid.2026.109048. Online ahead of print.
ABSTRACT
OBJECTIVES: Liver transplant recipients face increased cardiovascular disease (CVD) risk, but the pathogenesis is not clear. Cytomegalovirus (CMV) infection, which is common after liver transplantation, has been associated with cardiovascular events. Epicardial adipose tissue (EAT) could represent an unrecognized mediator of CMV-related cardiovascular risk. We aimed to investigate if prior CMV infection was associated with EAT volume in liver transplant recipients.
METHODS: From the national prospective Danish Comorbidity in Liver Transplant Recipients Study, we invited liver transplant recipients for protocolized research cardiac computed tomography and assessed EAT volume. Participants were systematically screened for CMV DNAemia and disease with repetitive post-transplantation PCR tests. Using linear regressions, we investigated the relationship between prior CMV infection and EAT volume indexed to body surface area (iEAT).
RESULTS: We included 165 liver transplant recipients, of whom 54 had prior CMV DNAemia, and 20 had prior CMV disease. Both were associated with lower iEAT, -7.52 (95% CI: -14.1, -0.99) ml/m2 and -10.5 (95% CI: -19.8, -1.09) ml/m2 respectively, adjusted for age, sex, smoking, time since transplantation, steroid-use, dyslipidemia, and diabetes.
CONCLUSIONS: Prior CMV infection was associated with lower EAT volume, suggesting that CMV affects ectopic fat, and that CMV does not increase cardiovascular risk via EAT.
PMID:42612785 | DOI:10.1016/j.ijid.2026.109048