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Cytomegalovirus infection after liver transplantation in children
A Mellon1, R W Shepherd, J L Faoagali
1Department of Gastroenterology, Royal Children's Hospital, Brisbane, Queensland, Australia.
Insights
Cytomegalovirus (CMV) infection is common after pediatric liver transplants, causing significant illness and death. Current immunoprophylaxis strategies may not be sufficient for these vulnerable patients.
Area of Science:
- Hepatology
- Infectious Diseases
- Transplantation Immunology
Background:
- Cytomegalovirus (CMV) infection is a significant post-transplant complication, particularly in pediatric liver transplant recipients.
- Understanding risk factors and outcomes is crucial for managing CMV in this population.
Purpose of the Study:
- To investigate the incidence of CMV infection and disease in children undergoing liver transplantation.
- To analyze the impact of pretransplant recipient and donor serology, age, nutritional status, and graft type on CMV outcomes.
- To evaluate the effectiveness of current immunoprophylaxis strategies.
Main Methods:
- Retrospective analysis of 70 children receiving 79 liver transplants.
- Assessment of CMV infection (seroconversion or virus isolation) and disease (infection with clinical symptoms).
- Correlation of CMV status with pretransplant factors and graft characteristics.
Main Results:
- 37% of recipients developed CMV infection, and 11.5% developed CMV disease, with a 5% overall mortality directly related to CMV.
- Primary CMV infection occurred in 71% of CMV-negative recipients receiving CMV-positive grafts, with 7% mortality.
- Active secondary CMV infection (reactivation/reinfection) occurred in 60% of CMV-positive recipients, with 12.5% mortality.
- No significant differences in CMV rates were observed based on nutritional status or graft size (whole vs. reduced).
Conclusions:
- CMV infection poses a substantial risk of morbidity and mortality in pediatric liver transplant recipients.
- Clinical signs alone are insufficient for diagnosing CMV; routine investigations are necessary.
- The findings do not support limiting immunoprophylaxis to only CMV-seronegative recipients in pediatric liver transplantation.
Abstract:
Post-liver transplant cytomegalovirus (CMV) infection (seroconversion or virus isolation) and CMV disease (infection plus clinical signs and symptoms) were studied in relation to pretransplant recipient and donor serology, age, nutritional status and the effect of paediatric versus adult (reduced size) grafts. Of 70 children receiving 79 transplants, 26 (37%) had evidence of CMV infection, and eight (11.5%) had evidence of CMV disease, four of whom died. The primary infection rate (where the recipients were CMV negative) was 71% with mortality of 7% with most receiving a CMV-positive graft. The active secondary infection rate (reactivation or reinfection, where the recipients were CMV positive) was 60% with mortality of 12.5%. No significant differences in infection or disease rates were found comparing malnourished versus well-nourished patients, or between those who received whole or reduced-size grafts. The high prevalence of CMV infections supports the view that clinical signs alone are inadequate to direct investigations for CMV. Both primary and active secondary CMV infection can result in serious morbidity and mortality in children receiving liver transplants. These data do not support the strategy of providing immunoprophylaxis to seronegative recipients only, at least in paediatric liver transplantation.