Cytomegalovirus Infection After Transplantation in Pediatric Liver Recipients

Abstract

Introduction Cytomegalovirus infection (CMV) is a common complication in liver and other grafts recipients. Our purpose was to estimate the outcomes of prophylaxis of CMV in pediatric liver graft recipients with different types of immunosuppressive treatment. Methods The data of 100 pediatric patients who underwent Living donor liver transplantation (LDLT) between October 2011 and April 2015 were studied and examined for CMV after 6 and more months after procedure. For all patients the immunosuppressive protocol was as follows: basiliximab, tacrolimus, steroids; in 17 cases mycophenolates were added, in 4 cases – cyclosporine, in 3 cases – everolimus. In patients with high anti-ABO titres (more than 1:8) plasmapheresis and rituximab infusion were carried out pre- and postoperatively. The protocol of CMV-prophylaxis included pre- and posttransplant screening by polymerase chain reaction (PCR), universal CMV prophylaxis strategy for all recipients as long as needed of ganciclovir or valgancilovir. All cases of proven pre- and posttransplant CMV-infection were treated with valganciclovir or intravenous ganciclovir. All children received prophylaxis therapy from the day 1 after transplantation and during 200+ days, and usually was prolonged as long as needed in children who were PCR-positive in period of pause of prophylaxis. Results The mean observation period was 24 months (range 6-57 months). The incidence of CMV infection within 100 days posttransplant was 41%, 200 days – 45%, 300+ days – 77% despite of prophylaxis. The mean annually incidence of positive CMV PCR in group with standard immunosuppressive protocol was 0,92 (n=81). For the group of patients with modified immunosuppressive regimen the mean year level of CMV-infection was 1,04 (n=19). There was no difference of mean values between two groups (t= 0.5, p= 0.61). Conclusion CMV-prophylaxis includes long period of antiviral prophylaxis in all patients after LDLT. Antiviral therapy is necessary to used in all types of immunosuppressive treatment. Our results demonstrated safety and efficacy of universal prophylaxis of CMV disease in pediatric liver graft recipients.