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Cytomegalovirus infections in pediatric liver transplantation
S M King1, M Petric, R Superina
1Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Cytomegalovirus infection is common after pediatric liver transplants. A positive donor status significantly increases the risk of severe, fatal cytomegalovirus disease in these vulnerable patients.
Area of Science:
- Pediatric Transplant Surgery
- Infectious Diseases
- Virology
Background:
- Cytomegalovirus (CMV) poses a significant threat to pediatric liver transplant recipients.
- Understanding CMV infection incidence and risk factors is crucial for improving outcomes.
Purpose of the Study:
- To determine the incidence of cytomegalovirus infection in pediatric liver transplant recipients.
- To assess the severity of cytomegalovirus disease post-transplant.
- To investigate the relationship between recipient and donor cytomegalovirus serostatus and disease development.
Main Methods:
- Retrospective follow-up of 26 consecutive pediatric liver transplant recipients.
- Analysis of cytomegalovirus infection rates and disease severity.
- Correlation of patient and donor cytomegalovirus serostatus with infection outcomes.
Main Results:
- Overall cytomegalovirus infection incidence was 54% (14/26).
- Over 90% of patients with seropositive recipients or donors contracted cytomegalovirus.
- 43% of infected patients developed severe, fatal cytomegalovirus disease despite antiviral treatment.
- Two-thirds of post-transplant deaths were linked to severe cytomegalovirus infection.
Conclusions:
- A seropositive donor is a major risk factor for severe cytomegalovirus disease in pediatric liver transplant recipients.
- Cytomegalovirus infection significantly contributes to mortality in this patient population.
- Proactive management strategies considering donor serostatus are essential.
Abstract:
From 1986 to 1989, 26 consecutive pediatric liver transplant recipients were followed up at The Hospital for Sick Children, Toronto, Canada. The patients were reviewed to assess the incidence of infection with cytomegalovirus, the severity of disease, and the relationship of recipient and donor serostatus to cytomegalovirus disease. Overall, the incidence of infection was 54% (14/26). Over 90% of patients who were seropositive or whose donors were seropositive developed evidence of cytomegalovirus infection after transplantation. Forty-three percent (6/14) of those with cytomegalovirus infections developed severe, fatal cytomegalovirus disease, despite treatment with immunoglobulins and ganciclovir (Syntex Laboratories Inc, Palo Alto, Calif) or foscarnet sodium (Astra, Pharmaceutical Products Inc, Westborough, Mass). Of all posttransplant deaths, two thirds were associated with severe cytomegalovirus infection. Cytomegalovirus-related deaths occurred in three of four seronegative patients with seropositive donors and three of six seropositive patients with seropositive donors. Therefore, a seropositive donor appeared to be a major risk factor for severe cytomegalovirus disease.