title: Assessment of Cytomegalovirus Hybrid Preventative Strategy in Pediatric Heart Transplant Patients.
abstract: BACKGROUND
  Prevention strategies for cytomegalovirus (CMV) in pediatric transplant recipients are sparsely reported. A hybrid strategy that combines prophylaxis with preemptive therapy using serial CMV viral load monitoring is an emerging option. We report our clinical outcomes with a hybrid strategy in pediatric heart transplant recipients.
  
  
  METHODS
  A retrospective chart review was performed for pediatric heart transplant recipients who received a hybrid strategy of 2-4 weeks intravenous ganciclovir followed by serial whole blood CMV monitoring from 2002 to 2010. Subject demographics, medications, drug levels, serial CMV viral loads, intravascular ultrasound and angiography reports, and histopathology were collected. Descriptive statistics and patient groups were compared using χ(2), Fisher's exact, and Wilcoxon rank-sum tests.
  
  
  RESULTS
  Twelve females and 13 males, ranging from 4 months to 19 years of age, underwent 26 heart transplants. Mean follow-up was 39 months (range, 5-94 months). Fourteen (54%) subjects were CMV donor (D) + /recipient (R) - , 8 (31%) were D + /R + , and 4 (15%) were D - /R + . Six subjects (23%) died of complications unrelated to CMV. Median prophylaxis duration was 25 days (range, 7-70 days). Ten (38%) subjects developed CMV infection: 1 subject had 2 episodes of CMV syndrome, and 1 subject had 2 episodes CMV. Although 6 of 14 patients with coronary artery vasculopathy had prior CMV, no association was found (P = .81). Median time to first CMV DNAemia was 2.3 months (range, 9 days to 24.8 months). Median time to viral load clearance was 29 days (range, 4-233 days). In addition, 25 D - /R- patients were transplanted and received no prophylaxis; 2 (8%) patients developed CMV infection.
  
  
  CONCLUSIONS
  Pediatric heart transplant recipients who were at risk for CMV and treated with a novel preventative hybrid strategy developed CMV infection, syndrome, and disease at rates similar to those reported in literature for prophylactic strategies.
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland.
authors.forename: Angela
authors.initials: A
authors.lastname: Lin
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, and.
authors.forename: Sarah
authors.initials: S
authors.lastname: Worley
authors.affiliation: Department of Pediatric Cardiology, Pediatric Institute and The Children's Hospital at Cleveland Clinic;
authors.forename: Jennifer
authors.initials: J
authors.lastname: Brubaker
authors.affiliation: Department of Pediatric Cardiology, Pediatric Institute and The Children's Hospital at Cleveland Clinic;
authors.forename: Gerard
authors.initials: G
authors.lastname: Boyle
authors.affiliation: Department of Pediatric Cardiology, Pediatric Institute and The Children's Hospital at Cleveland Clinic;
authors.forename: Colleen
authors.initials: C
authors.lastname: Nasman
authors.affiliation: Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Ohio.
authors.forename: Camille
authors.initials: C
authors.lastname: Sabella
authors.affiliation: Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Ohio danzigl@ccf.org.
authors.forename: Lara A
authors.initials: LA
authors.lastname: Danziger-Isakov
keywords: Cytomegalovirus; Heart Transplantation; Pediatrics