title: Effectiveness of Preemptive Therapy for Cytomegalovirus Disease in Pediatric Liver Transplantation.
abstract: Most pediatric liver transplantation (LT) centers administer long courses of prophylaxis against cytomegalovirus (CMV) without evidence of benefit and with significant drug exposure and costs. We aimed at evaluating overall outcomes, direct and putative indirect effects of CMV, possible impact of viremia and risk factors for CMV infection in pediatric LT recipients managed with ganciclovir-based preemptive therapy (PET).
  
  
  
  The records of all the children who underwent LT between 2008 and 2014 were retrospectively analyzed.
  
  
  
  One hundred children were included. Three children had CMV disease; no CMV-related death or graft loss was recorded. The only identified risk factor for CMV infection was the donor/recipient serostatus (odds ratio, 17.23; 95% confidence interval, 1.88-157.87; P = 0.012), while viremia per se did not worsen LT outcomes, such as the incidence of acute rejection, Epstein-Barr virus infection, sepsis, biliary and vascular complications, nor graft dysfunction/loss or death at 3 and 5 years after LT. When compared with a historical cohort of children receiving ganciclovir prophylaxis, PET did not differ from prophylaxis for any of the selected outcomes, but was rather associated with lower antiviral drug exposure (6.4 ± 13 days vs 38.6 ± 14 days, P < 0.0001) and cost per patient (2.2 ± 3.9 k&OV0556; vs 6.6 ± 8.2 k&OV0556;, P = 0.001).
  
  
  
  PET is effective in controlling CMV in children receiving LT, with lower costs and lower exposure to antivirals.
authors.affiliation: 1 Pediatric Gastroenterology, Hepatology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy. 2 Microbiology and Virology, Hospital Papa Giovanni XXIII, Bergamo, Italy. 3 Infectious Diseases, Hospital Papa Giovanni XXIII, Bergamo, Italy. 4 General and Transplant Surgery, Hospital Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Nicastro
authors.forename: Sara
authors.initials: S
authors.lastname: Giovannozzi
authors.forename: Paola
authors.initials: P
authors.lastname: Stroppa
authors.forename: Valeria
authors.initials: V
authors.lastname: Casotti
authors.forename: Anna Paola
authors.initials: AP
authors.lastname: Callegaro
authors.forename: Alessandra
authors.initials: A
authors.lastname: Tebaldi
authors.forename: Claudio
authors.initials: C
authors.lastname: Farina
authors.forename: Michele
authors.initials: M
authors.lastname: Colledan
authors.forename: Lorenzo
authors.initials: L
authors.lastname: DʼAntiga
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control* / Q000821:virology; D004334:Drug Administration Schedule; D016527:Drug Costs; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D006801:Humans; D007223:Infant; D007558:Italy; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects* / Q000191:economics; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir