[Purpose] Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections are the most important viral infections in pediatric patients with transplant. Valganciclovir (VGCV) has been used as prophylaxis against CMV after pediatric living donor liver transplantation (LDLT). The purpose of this study was to examine the safety and efficacy of long-term VGCV prophylaxis therapy comparing with short-term one after pediatric LDLT.

[Method] VGCV was administered to children who received LDLT between March 2009 and October 2014. 41 patients enrolled in this study. CMV and EBV antibody status, pp65 antigenemia assay results, EBV viral load, and other laboratory data were assessed at 1 year after LDLT. Patients were divided in two groups: long-term group who had 1 year VGCV prophylaxis and short-term group who had less than 6 months prophylaxis.

[Result] There were 26 females and 15 males, with a mean age of 4.6 years at transplant. With regards to pre-transplant donor (D)/recipient (R) CMV antibody status, 12 were D positive(+)/R negative(-), 22 were D+/ R+, 4 were D-/R+ and 3 were D-/R-. For EBV, there were 17 D+/R+, 23 D+/R- and one D-/R- pairs. 21 patients were long-term group and 20 patients were short-term group. In short-term group, symptomatic CMV infection were observed in 7 patients (35%) with the CMV pp65 antigenemia assay positive in 3 or / and CMV IgM positive in 5. In long-term group, only one patient developed symptomatic CMV infection (1/21, 5%). Long term VGCV prophylaxis prevent CMV infection stasticaly significant (p=0.001). Furthermore 5 EBV R- patients (42%) out of EBV R-/D+ (n=12) kept seronegative in long term group, whereas no EBV R- (0%) patient out of EBV R-/D+ (n=11) kept seronegative in short term group. Long term VGCV prophylaxis prevent EBV seroconversion stasticaly significant (p=0.001). One post-transplant lymphoproliferative disorder (PTLD) was observed in short term group. White blood cell and platelet count at one year were 3000/mm3 and 265000/mm3 in long-term group. No adverse effects were observed.

[Conclusion] Long-term VGCV prophylaxis for CMV and EBV infection after LDLT is safe and suppressed CMV pp65 angigenemia and CMV and EBV related disease. It prevent seroconversion in EBV negative patients. Long-term VGCV was useful after pediatric LDLT.

CITATION INFORMATION: Ueno T, Yamanaka H, Takama Y, Tanaka N, Tazuke Y, Bessho K, Okuyama H. Long-Term vs Short-Term Valganciclovir Prophylaxis Use for Cytomegalovirus and Epstein-Barr Virus Infections in Pediatric Living Related Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).

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