A hybrid strategy for the prevention of cytomegalovirus-related complications in pediatric liver transplantation recipients

Rebecca P. Madan, Andrew L. Campbell, Gail F. Shust, Alissa R. Kahn, Birte Wistinghausen, Roberto Posada, Nanda Kerkar, Benjamin L. Shneider, Sukru Emre, Betsy Herold

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

BACKGROUND.: This single center, retrospective study describes experience with a hybrid prevention strategy combining short-course antiviral prophylaxis and preemptive cytomegalovirus (CMV) polymerase chain reaction (PCR) monitoring. METHODS.: One hundred twenty-two pediatric liver transplantation recipients were followed up for a median of 2.3 years posttransplantation. Subjects received a minimum of 14 days of postoperative ganciclovir, followed by monthly CMV PCR monitoring. RESULTS.: Forty-three CMV seronegative recipients received seropositive grafts and were considered high risk for CMV; 79 subjects were routine risk. CMV was detected by PCR in the absence of symptoms in 34.4% of subjects and was more likely in high risk than in routine risk recipients (58.1% vs. 21.8%, P=0.0001). Twelve subjects (9.8%) developed CMV disease (8 high risk vs. 4 routine risk, P=0.03). Three subjects developed acute rejection in the 6 months after detection of CMV, but CMV was preceded by rejection in 13 subjects. There were no mortalities secondary to CMV. A total of 38.5% of subjects were spared antiviral medications beyond their initial postoperative prophylaxis. CONCLUSIONS.: These results suggest that a hybrid preventative approach for CMV is a reasonable alternative to prolonged antiviral prophylaxis and may reduce unnecessary exposure to antiviral therapy. However, patients who receive intensified immunosuppression after acute rejection are at increased risk for CMV and may require extended prophylaxis and closer monitoring.

Original languageEnglish (US)
Pages (from-to)1318-1324
Number of pages7
JournalTransplantation
Volume87
Issue number9
DOIs
StatePublished - May 15 2009

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Cytomegalovirus
Liver Transplantation
Pediatrics
Antiviral Agents
Polymerase Chain Reaction
Ganciclovir
Immunosuppression
Retrospective Studies
Transplants
Mortality

Keywords

  • Cytomegalovirus
  • Pediatric liver transplantation
  • Preemptive therapy

ASJC Scopus subject areas

  • Transplantation

Cite this

A hybrid strategy for the prevention of cytomegalovirus-related complications in pediatric liver transplantation recipients. / Madan, Rebecca P.; Campbell, Andrew L.; Shust, Gail F.; Kahn, Alissa R.; Wistinghausen, Birte; Posada, Roberto; Kerkar, Nanda; Shneider, Benjamin L.; Emre, Sukru; Herold, Betsy.

In: Transplantation, Vol. 87, No. 9, 15.05.2009, p. 1318-1324.

Research output: Contribution to journalArticle

Madan, RP, Campbell, AL, Shust, GF, Kahn, AR, Wistinghausen, B, Posada, R, Kerkar, N, Shneider, BL, Emre, S & Herold, B 2009, 'A hybrid strategy for the prevention of cytomegalovirus-related complications in pediatric liver transplantation recipients', Transplantation, vol. 87, no. 9, pp. 1318-1324. https://doi.org/10.1097/TP.0b013e3181a19cda
Madan, Rebecca P. ; Campbell, Andrew L. ; Shust, Gail F. ; Kahn, Alissa R. ; Wistinghausen, Birte ; Posada, Roberto ; Kerkar, Nanda ; Shneider, Benjamin L. ; Emre, Sukru ; Herold, Betsy. / A hybrid strategy for the prevention of cytomegalovirus-related complications in pediatric liver transplantation recipients. In: Transplantation. 2009 ; Vol. 87, No. 9. pp. 1318-1324.
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AB - BACKGROUND.: This single center, retrospective study describes experience with a hybrid prevention strategy combining short-course antiviral prophylaxis and preemptive cytomegalovirus (CMV) polymerase chain reaction (PCR) monitoring. METHODS.: One hundred twenty-two pediatric liver transplantation recipients were followed up for a median of 2.3 years posttransplantation. Subjects received a minimum of 14 days of postoperative ganciclovir, followed by monthly CMV PCR monitoring. RESULTS.: Forty-three CMV seronegative recipients received seropositive grafts and were considered high risk for CMV; 79 subjects were routine risk. CMV was detected by PCR in the absence of symptoms in 34.4% of subjects and was more likely in high risk than in routine risk recipients (58.1% vs. 21.8%, P=0.0001). Twelve subjects (9.8%) developed CMV disease (8 high risk vs. 4 routine risk, P=0.03). Three subjects developed acute rejection in the 6 months after detection of CMV, but CMV was preceded by rejection in 13 subjects. There were no mortalities secondary to CMV. A total of 38.5% of subjects were spared antiviral medications beyond their initial postoperative prophylaxis. CONCLUSIONS.: These results suggest that a hybrid preventative approach for CMV is a reasonable alternative to prolonged antiviral prophylaxis and may reduce unnecessary exposure to antiviral therapy. However, patients who receive intensified immunosuppression after acute rejection are at increased risk for CMV and may require extended prophylaxis and closer monitoring.

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