title: Contrast patterns of Cytomegalovirus and Epstein-Barr virus infection in pediatric living-donor liver transplant recipients.
abstract: OBJECTIVE
  Cytomegalovirus and Epstein-Barr virus remain leading causes of morbidity and mortality in the living-donor liver transplant population, particularly in pediatric patients. Herein we compare the incidence, timing, and risk factors for infection in this group.
  
  
  METHODS
  We performed a retrospective study of 344 consecutive pediatric patients 193 women (56.1%) who received living-donor liver transplants at Kyoto University Hospital. Patients were followed-up for maximum 7.1 ± 3.6 years (range, 0.02-13.2 y) after surgery.
  
  
  RESULTS
  The mean age at the time of transplant was 3.95 ± 4.75 years (median, 1.38 y; range, 0.07-17.87 y). A total of 156 patients (45.2%) developed viral infections. Of those patients, 91 (26.5%) developed cytomegalovirus infection, and 93 (27%) developed Epstein-Barr virus. Cytomegalovirus developed at 39.3 ± 34.6 days, while Epstein-Barr virus developed 3.99 ± 3.67 years after transplant. Frequent rejection attacks (hazard ratio [HR],1.58; 95% confidence interval [CI]: 0.14-2.18; P = .006) were an independent predictor for postoperative cytomegalovirus infection, while preoperative cytomegalovirus seropositive results (HR, 1.76; 95% CI: 1.03-2.18; P = .038), short cold ischemia time (HR, 1.0; 95% CI: 0.99-1.0; P = .02), larger graft (HR, 1.3; 95% CI: 1.00-1.73; P = .047), and new cases compared to old cases (HR, 2.27; 95% CI: 1.14-4.52; P = .019) were independent predictors for postoperative Epstein-Barr virus infection.
  
  
  CONCLUSIONS
  Extended surveillance of cytomegalovirus and Epstein-Barr virus DNAemia is recommended for pediatric patients receiving living-donor liver transplants, particularly infants who are at high risk, and especially those exposed to frequent attacks of rejection and those that receive larger grafts.
authors.affiliation: From the Department of Microbiology and Immunology, Graduate School of Medicine, Assiut University, Assiut, Egypt; and the Department of Hematology and Immunology, Graduate School of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
authors.forename: Hanaa
authors.initials: H
authors.lastname: Nafady-Hego
authors.forename: Hamed
authors.initials: H
authors.lastname: Elgendy
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D000293:Adolescent; D000367:Age Factors; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D019520:Living Donors; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D066027:Transplant Recipients; D016896:Treatment Outcome