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Cytomegalovirus infection after intestinal transplantation in children
1University of Pittsburgh, Department of Surgery, Children's Hospital of Pittsburgh, Pennsylvania, USA.
Abstract:
Sixteen episodes of cytomegalovirus (CMV) disease occurred in 10 of 41 children undergoing intestinal transplantation from 1990 to 1995. Stratification of CMV disease by donor (D)/recipient (R) serological status was as follows: 3 of 8, D+/R-; 3 of 9, D+/R+; 4 of 9, D-/R+; and 0 of 15, D-/R-. Treatment resulted in resolution of CMV disease in 93.3% of episodes. No deaths attributable to CMV disease occurred in this series. CMV in D+/R- children resulted in more extensive and persistent disease. However, patient and graft survival rates were similar in the different D/R subgroups and between children with and without CMV disease. Cumulative dose of steroid boluses (relative risk [RR], 1.59; 95% confidence interval [CI], 1.14-2.21) and history of steroid recycles (RR, 2.72; 95% CI, 1.21-6.13) were associated with CMV disease. These results suggest that although CMV-associated morbidity in pediatric intestinal transplant recipients was substantial, it was not associated with an increased rate of mortality or graft loss, even among high-risk D+/R- patients.
Insights
Cytomegalovirus (CMV) disease is common in pediatric intestinal transplant recipients, especially D+/R- cases, but treatment is effective. CMV infection did not impact long-term survival or graft success in these children.
Area of Science:
- Pediatric transplantation
- Infectious diseases
- Immunology
Background:
- Cytomegalovirus (CMV) infection is a significant concern in pediatric intestinal transplantation.
- Understanding CMV disease epidemiology and risk factors is crucial for patient management.
Purpose of the Study:
- To analyze the incidence, characteristics, and outcomes of cytomegalovirus (CMV) disease in pediatric intestinal transplant recipients.
- To identify risk factors associated with CMV disease in this population.
Main Methods:
- Retrospective analysis of 41 pediatric intestinal transplant recipients from 1990 to 1995.
- Stratification of cytomegalovirus (CMV) disease by donor (D) and recipient (R) serological status (D+/R-, D+/R+, D-/R+, D-/R-).
- Assessment of treatment efficacy, mortality, graft survival, and associated risk factors, including steroid use.
Main Results:
- Sixteen episodes of cytomegalovirus (CMV) disease occurred in 10 children (24.4%).
- The D+/R- group experienced more extensive and persistent CMV disease.
- Treatment resolved CMV disease in 93.3% of episodes; no CMV-attributable deaths occurred.
- Cumulative steroid dose and history of steroid recycles were associated with CMV disease.
- Patient and graft survival rates were similar across CMV disease status and D/R subgroups.
Conclusions:
- Cytomegalovirus (CMV) disease in pediatric intestinal transplant recipients leads to substantial morbidity but does not increase mortality or graft loss.
- High-risk D+/R- patients require careful monitoring, but outcomes remain favorable with effective treatment.
- Steroid exposure is a significant risk factor for CMV disease development in this cohort.