Pediatr Gastroenterol Hepatol Nutr.  2017 Sep;20(3):178-185. 10.5223/pghn.2017.20.3.178.

Cytomegalovirus Infection under a Hybrid Strategy in Pediatric Liver Transplantation: A Single-Center Experience

Affiliations
  • 1Department of Pediatric, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea. seakhee.oh@amc.seoul.kr
  • 2Department of Pediatric Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

PURPOSE
To evaluate the outcomes of a hybrid prophylactic strategy to prevent cytomegalovirus (CMV) disease in pediatric liver transplantation (LT) patients.
METHODS
CMV DNAemia was regularly monitored by quantitative nucleic acid amplification test (QNAT) and was quantified in all children. CMV infection and disease were defined according to the International Consensus Guidelines. The hybrid strategy against CMV infection consisted of universal 3-week prophylaxis and preemptive treatment of intravenous ganciclovir regardless of the recipient's serostatus.
RESULTS
A total of 143 children who underwent living donor LT were managed using the hybrid strategy. The overall incidence of CMV infection by QNAT was 48.3% (n=69/143). The highest CMV DNAemia positivity was observed in 49.2% (n=60/122) of children in the D+/R+ group, followed by 46.7% (n=7/15) in the D+/R− group. CMV disease was noted in 26.1% (n=18/69) patients. Forty-three (62.3%) children had undergone preemptive therapy consisting of intravenous ganciclovir. No symptomatic patients developed tissue-invasive disease, resulting in no CMV-associated mortality.
CONCLUSION
The incidence of CMV infection was high in pediatric LT patients despite the hybrid strategy. However, tissue-invasive disease in pediatric LT did not occur.

Keyword

Cytomegalovirus; Liver transplantation, Child; Hybrid strategy; Quantitative nucleic acid amplification test

MeSH Terms

Child
Consensus
Cytomegalovirus Infections*
Cytomegalovirus*
Ganciclovir
Humans
Incidence
Liver Transplantation*
Liver*
Living Donors
Mortality
Nucleic Acid Amplification Techniques
Ganciclovir

Figure

  • Fig. 1 Cumulative rate of cytomegalovirus (CMV) infection. Most CMV infections occurred within 3 months posttransplantation.

  • Fig. 2 (A) Cumulative rate of graft survival and acute rejection according to cytomegalovirus (CMV) infection; CMV infection did not affect the cumulative rate of graft survival (p=0.701 in log-rank test). (B) The cumulative rate of acute rejection was higher after CMV infection than in patients without CMV infection (p=0.027).


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