title: A universal preemptive therapy for cytomegalovirus infections in children after live-donor liver transplantation.
abstract: BACKGROUND
  Cytomegalovirus (CMV) infection remains the most common and critical viral infection that occurs after liver transplantation (LT). The current set of guidelines recommends prophylaxis over a preemptive therapy for pediatric LT; however, the data regarding the optimal approach after LT in children are limited.
  
  
  METHODS
  We conducted a universal preemptive therapy for CMV infection in 113 children (median: 16 months) after live-donor LT at the largest pediatric LT center in Japan between November 2005 and August 2009. CMV-pp65 antigenemia was monitored weekly regardless of the subjects' CMV serostatus after LT, and ganciclovir therapy was initiated when CMV-pp65 antigenemia was positive.
  
  
  RESULTS
  The overall success rate of LT was 91.7%. CMV-pp65 antigenemia became positive in 37 (33%) recipients, and the positivity with their CMV serostatus was as follows: donor (D)+/recipient (R)-: 62%, D+/R+: 36%, D-/R+: 11%, and D-/R-: 8%. Among the D+/R- (n=29) and D+/R+ (n=44) recipients, 38% (n=11) and 64% (n=28) recipients were able to avoid the use of ganciclovir, respectively. Human CMV disease was documented in six (5%) recipients, and they were successfully treated with ganciclovir without any sequelae.
  
  
  CONCLUSIONS
  A universal preemptive therapy for CMV infection after live-donor LT was successful for reducing the use of antiviral agents and for controlling CMV infection and disease in children.
authors.affiliation: Division of Infectious Diseases, Department of Medical Specialties, National Center for Child Health and Development, Tokyo, Japan. saitoh-aki@ncchd.go.jp
authors.forename: Akihiko
authors.initials: A
authors.lastname: Saitoh
authors.forename: Seisuke
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Akinari
authors.initials: A
authors.lastname: Fukuda
authors.forename: Takanobu
authors.initials: T
authors.lastname: Shigeta
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Kakiuchi
authors.forename: Shinya
authors.initials: S
authors.lastname: Kamiyama
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Katsuta
authors.forename: Kensuke
authors.initials: K
authors.lastname: Shoji
authors.forename: Chikara
authors.initials: C
authors.lastname: Ogimi
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
mesh_terms: D000293:Adolescent; D000328:Adult; D000956:Antigens, Viral / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000188:drug therapy*; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D010750:Phosphoproteins / Q000097:blood; D000077562:Valganciclovir; D014763:Viral Matrix Proteins / Q000097:blood
chemical_list: D000956:Antigens, Viral; D000998:Antiviral Agents; D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa; D000077562:Valganciclovir; D015774:Ganciclovir