title: Current prevention strategies against cytomegalovirus in the studies in pediatric liver transplantation (SPLIT) centers.
abstract: Cytomegalovirus (CMV) continues to be a significant posttransplant infectious complication after pediatric liver transplant (PLT). The optimal prevention strategy is not currently known. To assess current CMV prevention practices, a web-based survey was conducted within the North American Studies in Pediatric Liver Transplantation (SPLIT) network. Twenty-nine of the 31 centers (94%) surveyed responded. Only seven centers reported evidence-based development of protocols. For most at-risk (donor or recipient CMV seropositive) PLT recipients, a prophylactic strategy predominates current practice. For high-risk (D+/R-), only three centers used nonprophylaxis-based protocols: one preemptive and two sequential/hybrid. Duration of prophylaxis ranged from 84 to 730 days with 14 centers using around 100 days and nine centers using around 200 days. Initial therapy with ganciclovir followed by valganciclovir was the most common strategy. For lower-risk recipients (CMV D-/R-), more centers (10/29) employed a preemptive strategy while the remainder described prophylaxis (15) and sequential/hybrid (3) strategies. Prophylaxis predominates current CMV prevention strategies for at-risk recipients within SPLIT. The variation in duration of therapy provides the opportunity to perform comparative effectiveness studies within SPLIT.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: L
authors.initials: L
authors.lastname: Danziger-Isakov
authors.forename: J
authors.initials: J
authors.lastname: Bucavalas
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000517:prevention & control*; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D017093:Liver Failure / Q000150:complications* / Q000601:surgery*; D016031:Liver Transplantation; D010372:Pediatrics / Q000379:methods; D011183:Postoperative Complications; D012306:Risk; D011795:Surveys and Questionnaires; D013601:T-Lymphocytes / Q000166:cytology; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir
keywords: Cytomegalovirus; pediatric transplantation; preemptive therapy; prophylaxis