*Purpose: To report the incidence cytomegalovirus (CMV) infection (CMV-I) and disease (CMV-D) in a cohort of pediatric liver transplant recipients under preemptive therapy, identify risk factors for CMV-I/D, analyze CMV related complications and document adverse reactions to antiviral treatment.

*Methods: All pediatric liver transplant recipients from a single center (1998-2018) were included. Antigenemia pp65 (AgPP65) was used from 1998-2003 and Nucleic Acid Amplification Test (NAT) starting in 2003, to inform preemptive therapy. These tests were conducted every 15 days for the first 6 months, then monthly for 6 months and afterwards every 3 months. CMV-I was defined as evidence of any viral replication and CMV-D as evidence of viral replication with symptoms or tissue invasive disease. The cut-off value for starting treatment was AgPP65>10 cells/200,000 or NAT>1500 copies/ml or any value in high-risk recipients (D+/R-). Initially, IV ganciclovir and more recently PO valganciclovir or a combination of both were used.

*Results: 118 pediatric liver transplant recipients were included, 63% were toddlers or preschool children, 24% were D+/R-, and the most common indication was Biliary Atresia (35%). CMV-I was detected in 67% of the patients, most of them were asymptomatic or self-limited, and only 38% reached the threshold for treatment. Only 5 patients (4%) developed CMV-D (3 viral syndromes and 2 hepatitis), in 2 of them the donor was CMV-IgM+ at the time of transplantation. All patients responded well to treatment and no graft or patient were lost to CMV. There were no differences in mortality, CMV indirect effects or other complications between those who required treatment and those who did not. Thirty one percent of the patients who received treatment, developed an adverse hematological reaction (thrombocytopenia 24%, anemia 13%, leucopenia 11%, neutropenia 2%) and 6 developed a subsequent episode of viral replication that responded well to a second course of treatment. Risk factors associated with CMV-I requiring treatment were: D+/R- (OR 13.9 p=0.01), fulminant hepatitis (OR 4.8 p=0.02) and thymoglobulin (OR 7 p=0.08).

*Conclusions: Preemptive therapy for CMV in children is safe and effective, yields low rates of CMV-I that requires treatment and low rates of CMV-D, without increasing CMV-related complications. By using this strategy, 62% of our patients did not receive treatment and therefore; drug exposure, costs, adverse reactions and the risk of resistance were minimized.

« Back to 2020 American Transplant Congress