A retrospective study of preventing early-stage cytomegalovirus infection after pediatric living donor liver transplantation

Abstract

Objective To explore the effectiveness of different preventive strategies for preventing early stage cytomegalovirus (CMV) infection after pediatric living donor hepatic transplantation. Methods The perioperative records were retrospectively analyzed for 146 children undergoing living-related liver transplants between 2015 and 2016. According to the status of postoperative medication, they were divided into prophylaxis (n=74) and preemptive treatment (n=72) groups. Ganciclovir was offered for preventing CMV infection in preemptive group postoperatively. In preemptive treatment group, no drugs were given for preventing CMV infection postoperatively, only ganciclovir was given when CMV DNA was positive. CMV infection was compared between two groups within 180 days postoperatively. Results No significant inter-group difference existed in perioperative records except for length of intensive care unit (ICU) stay. CMV infection was detected in 58 recipients (39.73%) after transplantation and there were concomitant abnormal hepatic function (n=8) and gastrointestinal symptoms (n=1). All of them recovered from CMV infection after ganciclovir treatment and the time of initial infection was (65.22±30.90) days. The infection rate was (31/74)41.89% in prophylaxis group and time of initial infection (68.03±29.83) days. The infection rate in preemptive treatment group was 37.50% (27/72) and time of first infection (62.00±32.34) days. CMV infection rate was 41.89% in prophylaxis group and 37.50% in preemptive treatment group. No statistical inter-group differences existed in CMV infection rate or infection time. Conclusions Antiviral prophylaxis fails to reduce the infection rate of CMV. And preemptive treatment is an effective prevention for CMV so that it may avoid unnecessary drug use, reduce the burden of patients' families and avoid drug side effects. Key words: Cytomegalovirus; Chlid; Liver transplantations; Preemptive therapy