Ganciclovir Improves Transplant-Free Liver Survival in Children With Biliary Atresia and Concurrent Cytomegaloviral...

To investigate the effect of post-operative ganciclovir therapy on transplant-free liver survival in children with biliary atresia (BA) complicated by cytomegalovirus (CMV) infection, and to propose an intervention mechanism hypothesis based on the 'CMV-hepatic stellate cell-fibrosis-long-term prognosis' pathogenic axis.

This retrospective study included children diagnosed with BA complicated by CMV infection at a tertiary children's hospital between January 2017 and October 2023. Patients were divided into a treatment group and a non-treatment group based on whether ganciclovir was administered for ≥ 1 week within 3 months after Kasai portoenterostomy (KPE). All patients had follow-up of at least 2 years by 1 October 2025. Baseline characteristics and clinical outcomes (transplant-free liver survival time and 3-month post-operative jaundice clearance rate) were compared between groups. Kaplan-Meier analysis was used to generate survival curves, and differences were assessed using the Log-Rank test. Evidence from basic and clinical research was integrated to construct a mechanistic hypothesis diagram for CMV-driven hepatic fibrosis and antiviral intervention.

A total of 17 children with BA were included, with 6 in the treatment group and 11 in the non-treatment group. Baseline characteristics indicated no significant differences between the two groups in terms of sex, hepatic fibrosis stage, age at surgery, preoperative DBIL and other clinical indicators, demonstrating balanced comparability (p > 0.05). Comparison of clinical outcomes and Kaplan-Meier survival curves showed that transplant-free liver survival time was significantly longer in the treatment group than in the non-treatment group: 1518 (217, 2825) versus 190 (83, 265) days, p = 0.035; the survival curve showed an improving trend (Log-Rank p = 0.087). The 3-month post-operative jaundice clearance rate did not differ significantly between groups (p > 0.05). The mechanistic hypothesis diagram suggested that CMV may activate hepatic stellate cells via multiple pathways, including CCL19/CCR7 and TGF-β, accelerating fibrosis progression, while ganciclovir may block this process.

Ganciclovir antiviral therapy may be associated with improved transplant-free liver survival in CMV-positive children with BA, exerting a specific effect on long-term fibrosis progression rather than short-term bile drainage. This clinical observation aligns with the 'CMV-fibrosis-long-term prognosis' pathogenic axis hypothesis and provides preliminary evidence for clinical antiviral treatment.