title: Fulminant Hepatic Failure as a Risk Factor for Cytomegalovirus Infection in Children Receiving Preemptive Therapy After Living Donor Liver Transplantation.
abstract: BACKGROUND
  Cytomegalovirus (CMV) is one of the most common causes of infection after solid organ transplantation with symptomatic disease occurring at an incidence of 20% to 40% without preventative measures. Although CMV donor+/recipient - serostatus is well known to be a risk factor, there is little data about other risk factors for CMV infection in the setting of pediatric liver transplantation (LT). We hypothesized that fulminant hepatic failure (FHF) may be a risk factor for CMV infection given anecdotal reports of complications associated with FHF.
  
  
  METHODS
  We conducted medical chart review of children who underwent LT at a tertiary children's hospital in Tokyo between November 2005 and October 2015. We evaluated the risk factors, especially FHF, and prognosis for CMV infection under preemptive therapy.
  
  
  RESULTS
  Three hundred thirty-seven living donor LT were analyzed. Underlying diseases were cholestatic liver disease (n = 172, 51%), metabolic disease (n = 59, 18%), and FHF (n = 51, 15%). Among 337 LT, 147 (44%) recipients developed CMV antigenemia. In multivariate analysis, FHF (odds ratio, 4.99; 95% confidence interval, 1.86-13.40; P = 0.001) and CMV serostatus were independent risk factors for developing CMV antigenemia. Positive donor serostatus was significantly associated with development of antigenemia within 1-year post-LT regardless of recipient serostatus (P <0.001). On the other hand, positive recipient status was associated with CMV antigenemia in the first 21 days (P <0.001). Only 12 (3.6%) of 337 children developed CMV disease.
  
  
  CONCLUSIONS
  Fulminant hepatic failure was found to be a risk factor for CMV infection independent of CMV serostatus.
authors: 1 Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan. 2 Department of Social Medicine, National Research Institute for Child Health and Development, Setagaya-ku, Tokyo, Japan. 3 Division of Transplant Surgery, Department of Surgery, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan.
authors: Munehiro
authors: M
authors: Furuichi
authors: Takeo
authors: T
authors: Fujiwara
authors: Akinari
authors: A
authors: Fukuda
authors: Mureo
authors: M
authors: Kasahara
authors: Isao
authors: I
authors: Miyairi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000209:etiology*; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017114:Liver Failure, Acute / Q000150:complications*; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D012307:Risk Factors