Introduction: Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections are the most common viral infections after solid organ transplantation. Especially in pediatric patients, primary infection may cause significant morbidity and mortality if not treated promptly. Valganciclovir has been used as prophylaxis against CMV after pediatric liver transplantation. However, infection has been observed shortly after discontinuation of prophylactic valganciclovir. The purpose of this study was to examine the efficacy and safety of long-term valganciclovir prophylaxis therapy after pediatric living related liver transplantation.
Methods: Valganciclovir was administrated to children who received living donor liver transplantation (LDLT) between March 2010 and the end of 2011 in our institution. Valganciclovir was continued until steroids were discontinued, up to one year after LDLT. Ten patients who received valganciclovir for 12 months were enrolled. Patient demographics and data were gathered from a prospectively recorded database and chart review. CMV and EBV antibody status, pp65 antigenemia assay results, EBV viral load, and other laboratory data were assessed at 1 year after transplantation.
Results: There were 8 females and 2 males, with a mean patient age of 4.8 years at transplant. Pretransplant donor (D)/recipient (R) CMV antibody status included D+/R+ (n=6) and D+/R- (n=5). Pretransplant donor/recipient EBV antibody status included D+/R+ (n=6) and D+/R- (n=5). The CMV-pp65 antigenemia assay became positive in 1 patient (9%). Among CMV D+/R- patients, 4 (80%) became CMV seropositive. Among EBV D+/R- patients, 4 (80%) became EBV seropositive. Among EBV D+/R+ patients, 1 (16%) became EBV seronegative. No clinical CMV or EBV infections were observed. No Post-transplant lymphoproliferative disorder was observed during the study period. Mean white blood cell and platelet counts at 1 year were 3000/mm3 and 265000/mm3, respectively.
Conclusions: Prolonged valganciclovir prophylaxis for CMV and EBV infection after LDLT is safe. Valganciclovir suppressed CMV pp65 antigenemia and CMV and EBV related disease although it failed to prevent seroconversion. More prospective studies are required to evaluate the efficacy of prolonged valganciclovir prophylaxis.
To cite this abstract in AMA style:Ueno T, Ibuka S, Masahata K, Nomura M, Nara K, Uehara S, Soh H, Oue T, Kondou H, Usui N. Efficacy and Safety of Prolonged Valganciclovir Prophylaxis in Children after Living Donor Liver Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/efficacy-and-safety-of-prolonged-valganciclovir-prophylaxis-in-children-after-living-donor-liver-transplantation/. Accessed April 2, 2020.
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