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Positive donor serostatus predicts CMV infection in pediatric liver transplantation
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MEMPHIS, Tenn. —Positive cytomegalovirus antigenemia was associated with positive recipient serostatus within 21 days of liver transplantation and positive donor serostatus within 1 year of transplant among pediatric transplant patients, according to data presented at the St. Jude/PIDS Pediatric Transplant ID Symposium.
Researchers conducted a retrospective cohort study from November 2005 to July 2014 to identify risk factors for cytomegalovirus (CMV) infection after liver transplantation among children. Approximately 3 weeks after transplantation, whole blood CMV antigen was monitored weekly. Ganciclovir or valganciclovir was initiated if a patient developed CMV antigenemia. The study cohort consisted of 280 children (median age, 14 months).
Of the 130 patients who developed CMV antigenemia, 104 were treated, including 34 who required treatment beyond 21 days.
Forty-five children relapsed with CMV antigenemia after pre-emptive therapy. ABO blood type incompatibility increased this risk more than fourfold (P = .002).
Positive donor CMV serostatus was associated with development of antigenemia within 1 year after transplantation regardless of recipient serostatus (P < .001).
Development of CMV antigenemia within 21 days following transplantation was linked with positive recipient serostatus (P = .005) but not donor serostatus.
Fulminant hepatic failure was a risk factor for developing CMV antigenemia (OR = 3.463; P < .001) and requiring treatment for more than 21 days (OR = 6.79; P < .001).
“Positive CMV antigenemia was associated with positive recipient serostatus within 21 days of liver transplantation, and positive donor serostatus within 1 year of liver transplantation,” study researcher Munehiro Furuichi, MD, of the National Center for Child Health and Development in Tokyo, and colleagues concluded. “Fulminant hepatic failure was a risk factor for developing CMV antigenemia.” – by Amanda Oldt
Reference:
Furuichi M, et al. Abstract T1501. Presented at: St. Jude/PIDS Pediatric Infectious Diseases Research Conference; Feb. 20-21, 2015; Memphis, Tennessee.
Disclosure: The study was funded by the National Center for Child Health and Development.
Perspective
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Lara Danziger-Isakov, MD, MPH
Furuichi and colleagues report their results of cytomegalovirus (CMV) antigenemia testing after pediatric liver transplant in a cohort of 280 patients evaluated over the past decade. While quantitative CMV PCR is more commonly employed for CMV monitoring, CMV antigenemia has been an accepted monitoring strategy, according to the Updated International Consensus Guidelines on the Management of Cytomegalovirus in Solid Organ Transplantation.
Interestingly, the authors report differences in risk for CMV infection based on donor (D) and recipient (R) serostatus that are correlated with the time post-transplant. Within the first 21 days of transplant, CMV R+ serostatus is associated with CMV activity, while positive CMV D+ serostatus was not. However, within one year of transplant CMV D+ serostatus was associated with CMV antigenemia. This may indicate that early infections are primarily related to reactivation of virus from the recipient rather than acquired from the donor during the transplant. This provides additional insight into the method by which prevention might be employed perhaps indicating that prophylaxis or hybrid strategy of CMV prevention would be preferred over a pre-emptive strategy for CMV R+ recipients.
The authors reported a substantial proportion of treated patients (45 of 104) developed a CMV relapse after completing pre-emptive therapy. However, risks for relapse aside from ABO incompatibility were not discussed but could further enhance the understanding of managing these patients.
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