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Updated: Oct 16, 2026
Expanding Cytotoxic T Lymphocytes from Umbilical Cord Blood that Target Cytomegalovirus, Epstein-Barr Virus, and Adenovirus
Published on: May 7, 2012
Optimized Cytomegalovirus-DNA Threshold for Preemptive Therapy in Pediatric Liver Transplant Recipients: A
Matteo Pelucchi1,2, Eleonora Severi1,2, Michele Totaro3
1Pediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy.
Background:
Cytomegalovirus (CMV) remains one of the most significant infectious complications after pediatric liver transplantation (LT). Although preemptive therapy (PET) is an effective and widely supported strategy, the choice of a clinically actionable CMV-DNA threshold varies substantially among centers. We aimed to evaluate below-standard CMV-DNA thresholds able to accurately predict clinically significant infection (CSI) while preventing overtreatment in children after LT.
Methods:
In this prospective observational study, 66 children were followed for 6 months post-LT with scheduled whole-blood CMV-DNA monitoring. CMV-DNA trajectories were evaluated using mixed-effects spline models and compared by clinical outcome and serologic risk. Threshold performance was assessed through interpolated viral-load curves for all infected patients. Sensitivity, overtreatment rate, and positive predictive value (PPV) were estimated for the candidate thresholds.
Results:
CSI occurred in 19/66 patients (28.7%), while 28 had abortive infections (AI), and 19 showed no infection. CSI displayed significantly higher and more sustained CMV-DNA trajectories compared with AI (p < 0.0001). Serologic risk did not modify viral kinetics. Threshold analysis identified 40 000 IU/mL (57 140 copies/mL) as the optimal PET cut-off: it treated all CSI cases (sensitivity 94.7%, 95% CI 88.9-100), resulted in no overtreatment, and maintained high PPV (100%). Lower thresholds increased overtreatment (up to > 50%), while higher ones added no clinical advantage.
Conclusions:
A CMV-DNA threshold of 40 000 IU/mL in whole blood optimally balances timely PET initiation with avoidance of unnecessary antiviral therapy. These findings support a standardized, clinically pragmatic approach to PET in pediatric LT.
