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Int."],"abstract":"<jats:p>In patients with hepatocellular carcinoma (HCC), undergoing liver transplantation (LT), cytomegalovirus reactivation (CMVr) may modulate the immune system to prevent tumor recurrence. In this multicenter retrospective study (2010\u20132015) involving 15 institutions, we assessed the effect of early CMVr in tumor recurrence rates among 771-LT HCC patients with tacrolimus-based immunosuppression (88% men, mean age 58\u00a0years). CMV prophylaxis was implemented for 19.7% of patients, while the rest were managed with preemptive therapy. The Milan criteria were met by 88% of patients. Microvascular invasion was present in 12.7% of explanted livers. The serum AFP level before transplantation was 5.1 (3\u201315) ng\/mL. After a median follow-up of 7.4\u00a0years, 101 patients (13%) experienced HCC recurrence. CMVr occurred in 235 patients (30.5%) at a median of 41.5\u00a0days post-LT and 42 patients (5.6%) had CMV disease. Cumulative exposure to tacrolimus within the first 3\u00a0months after LT was similar among patients with and without CMVr. In a multivariate Cox regression analysis, factors associated with an increased rate of HCC recurrence included microvascular invasion [HR:2.82, CI95%:1.55\u20135.14; p 0.0001], donation after circulatory determination of death [HR:4.43,CI95%:1.52\u201312.9; p 0.006) and diameter of the main nodule at explant [HR:1.04, CI95%:1.02\u20131.06; p &amp;lt; 0.001]. Meanwhile CMVr [HR:0.46, CI95%:0.23\u20130.93, p 0.031] and MELD [HR:0.93, CI95%:0.87\u20130.99; p0.017] exhibited protective effects. In conclusion, early CMVr may protect against HCC recurrence. 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