A hybrid strategy for the prevention of cytomegalovirus-related complications in pediatric liver transplantation recipients.
BACKGROUND
This single center, retrospective study describes experience with a hybrid prevention strategy combining short-course antiviral prophylaxis and preemptive cytomegalovirus (CMV) polymerase chain reaction (PCR) monitoring.


METHODS
One hundred twenty-two pediatric liver transplantation recipients were followed up for a median of 2.3 years posttransplantation. Subjects received a minimum of 14 days of postoperative ganciclovir, followed by monthly CMV PCR monitoring.


RESULTS
Forty-three CMV seronegative recipients received seropositive grafts and were considered high risk for CMV; 79 subjects were routine risk. CMV was detected by PCR in the absence of symptoms in 34.4% of subjects and was more likely in high risk than in routine risk recipients (58.1% vs. 21.8%, P=0.0001). Twelve subjects (9.8%) developed CMV disease (8 high risk vs. 4 routine risk, P=0.03). Three subjects developed acute rejection in the 6 months after detection of CMV, but CMV was preceded by rejection in 13 subjects. There were no mortalities secondary to CMV. A total of 38.5% of subjects were spared antiviral medications beyond their initial postoperative prophylaxis.


CONCLUSIONS
These results suggest that a hybrid preventative approach for CMV is a reasonable alternative to prolonged antiviral prophylaxis and may reduce unnecessary exposure to antiviral therapy. However, patients who receive intensified immunosuppression after acute rejection are at increased risk for CMV and may require extended prophylaxis and closer monitoring.
Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY 10461, USA. rmadan@aecom.yu.edu
Rebecca P
RP
Madan
Andrew L
AL
Campbell
Gail F
GF
Shust
Alissa R
AR
Kahn
Birte
B
Wistinghausen
Roberto
R
Posada
Nanda
N
Kerkar
Benjamin L
BL
Shneider
Sukru
S
Emre
Betsy C
BC
Herold
D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000235:genetics; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D004279:DNA, Viral / Q000032:analysis; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects*; D016133:Polymerase Chain Reaction / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control / Q000821:virology; D012189:Retrospective Studies; D018570:Risk Assessment; D040242:Risk Reduction Behavior; D013997:Time Factors; D014766:Viremia / Q000453:epidemiology
D000998:Antiviral Agents; D004279:DNA, Viral; D015774:Ganciclovir