Risk factors of cytomegalovirus infection after pediatric liver transplantation
Purpose:
Cytomegalovirus (CMV) infection is known to be the most frequently viral infection among patients after liver transplantation. This is especially true in pediatric living-donor liver transplantation because the recipients have often not been infected with CMV and postoperative primary infection with CMV frequently occurs.
Patients And Methods:
Of 93 patients who underwent pediatric liver transplantation at our department, 33 patients (36.3%) were diagnosed with CMV infection using the antigenemia method (C7-HRP). Retrospective review and statistical analysis were conducted to confirm risk factors of post-transplantation CMV infection.
Result:
Positive lymphocytes were diagnosed between postoperative days 8 and 111 after transplantation. Ganciclovir or foscavir were administrated to 21 patients. The other 10 patients who had one positive lymphocyte were observed and the cell disappeared on follow-up examination. We did not observe any cases of positive lymphocytes with C7-HRP in patients who received a graft from a CMV antibody-negative donor. Independent predictors associated with CMV infection in the multivariable analysis were administration of OKT3 and grafts from CMV antibody-positive donors.
Conclusion:
In CMV infection after pediatric liver transplantation, cases with CMV antibody-positive donors and with OKT3 administration for acute rejection are considered high risk, and cases with CMV antibody-negative donors are considered low risk.
Insights
Cytomegalovirus (CMV) infection is a significant risk after pediatric liver transplants. Receiving grafts from CMV antibody-positive donors and OKT3 administration are key risk factors for post-transplant CMV infection.
Area of Science:
- Hepatology
- Virology
- Transplantation Immunology
Background:
- Cytomegalovirus (CMV) infection is the most common viral infection post-liver transplantation.
- Pediatric living-donor liver transplant recipients are particularly vulnerable to primary CMV infection due to prior CMV-naïve status.
Purpose of the Study:
- To identify risk factors for post-transplantation Cytomegalovirus (CMV) infection in pediatric liver transplant recipients.
- To analyze the incidence and predictors of CMV infection following liver transplantation.
Main Methods:
- Retrospective review of 93 pediatric liver transplant patients.
- Diagnosis of CMV infection using the antigenemia method (C7-HRP).
- Statistical analysis to determine independent predictors of CMV infection.
Main Results:
- 36.3% of patients (33/93) were diagnosed with CMV infection.
- CMV infection was diagnosed between postoperative days 8 and 111.
- Independent predictors for CMV infection included OKT3 administration and grafts from CMV antibody-positive donors.
- No CMV infections were observed in recipients of grafts from CMV antibody-negative donors.
Conclusions:
- Pediatric liver transplant recipients receiving grafts from CMV antibody-positive donors are at high risk for CMV infection.
- Administration of OKT3 for acute rejection is a significant risk factor for CMV infection.
- Grafts from CMV antibody-negative donors are associated with a low risk of CMV infection.
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