title: Efficacy and safety of valganciclovir in liver-transplanted children infected with Epstein-Barr virus.
abstract: Epstein-Barr virus (EBV) infection after liver transplantation (LT) is associated with increased risk of posttransplant lymphoproliferative disorder (PTLD). Lowering immunosuppression is the current method to prevent PTLD in LT children with a high viral load. The aim of this study was to assess the efficacy and safety of valganciclovir (VGCV) in children with EBV infection after LT. Forty-seven children showing detectable EBV-DNA (72% asymptomatic) were treated with VGCV (520 mg/sqm twice daily) with no immunosuppression decrease (except in 4 cases). VGCV treatment started 17 months (median) after the onset of EBV infection. A 30-day treatment applied to 26 patients led to undetectable EBV-DNA in 11/32 courses (34.3%), with 82% relapsing. A long VGCV treatment (median: 8 months) achieved undetectable EBV-DNA in 20/42 (47.6%), 60% of whom maintained response off therapy. There were no new PTLD cases. Symptoms worsened in 1 (2.1%) in whom PTLD was suspected but not confirmed in liver and jejunum biopsies. Factors associated with achievement of undetectable EBV-DNA were a longer time from LT and a lower rate of intervening infections in comparison with nonresponders. The safety profile for VGCV was excellent. Graft rejection occurred in 6%. In conclusion, in 47 LT children with a sustained increased EBV load treated with VGCV and unchanged immunosuppression, PTLD was suspected in 1 child (2.1%). A viral load decrease could be achieved as EBV-DNA was undetectable in 47% of patients under prolonged treatment.
authors.affiliation: Pediatric Liver Service, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Loreto
authors.initials: L
authors.lastname: Hierro
authors.forename: Ruth
authors.initials: R
authors.lastname: Díez-Dorado
authors.forename: Carmen
authors.initials: C
authors.lastname: Díaz
authors.forename: Angela
authors.initials: A
authors.lastname: De la Vega
authors.forename: Esteban
authors.initials: E
authors.lastname: Frauca
authors.forename: Carmen
authors.initials: C
authors.lastname: Camarena
authors.forename: Gema
authors.initials: G
authors.lastname: Muñoz-Bartolo
authors.forename: Ana
authors.initials: A
authors.lastname: González de Zárate
authors.forename: Manuel
authors.initials: M
authors.lastname: López Santamaría
authors.forename: Paloma
authors.initials: P
authors.lastname: Jara
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000097:blood*; D020031:Epstein-Barr Virus Infections / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D015774:Ganciclovir / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006084:Graft Rejection / Q000209:etiology; D004854:Herpesvirus 4, Human / Q000187:drug effects; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007223:Infant; D007677:Kidney Function Tests; D008107:Liver Diseases / Q000209:etiology; D016031:Liver Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000517:prevention & control*; D012141:Respiratory Tract Infections / Q000209:etiology; D000077562:Valganciclovir; D014779:Virus Replication / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D000077562:Valganciclovir; D015774:Ganciclovir