G1-1701. A Hybrid Strategy for Prevention of CMV and EBV in Pediatric Liver Transplant Recipients
Session: Slide Session: Pediatric Infectious Diseases
Sunday, October 26, 2008: 12:00 AM
Room: Room 151B
Background: This single center, retrospective study details a hybrid strategy combining short course antiviral prophylaxis and preemptive CMV and EBV PCR monitoring. Methods: 122 pediatric liver transplant recipients were followed for a mean of 2.4 years post transplant. All subjects received a brief course of postoperative ganciclovir, followed by monthly CMV and EBV PCRs. Ganciclovir was reinitiated with CMV viremia or disease. Immunosuppression was reduced if subjects developed a detectable EBV viral load, with initiation of ganciclovir at the discretion of the transplant team. Results: 43 CMV seronegative recipients received a seropositive graft and were considered high risk for CMV complications, and 79 subjects were routine risk. CMV viremia was detected in 34.4% of subjects and was more frequent in high risk than routine risk recipients (58.1% vs. 21.8%, p=0.0001). 12 subjects (9.8%) developed CMV disease (8 high risk vs. 4 routine risk, p=0.03). 3 subjects developed acute rejection in the 6 months following detection of CMV, but CMV was preceded by rejection in 13 subjects. 57 subjects (46.7%) developed a detectable EBV PCR viral load, and 8 (6.5%) developed post transplant lymphoproliferative disorder (PTLD). Subjects with a higher peak EBV PCR value were at greater risk for PTLD. There were no mortalities secondary to CMV or EBV. 38.5% of subjects were spared antiviral medications beyond their initial postoperative prophylaxis. Conclusions: These results suggest that a hybrid preventative approach for CMV and EBV is safe and effective but requires aggressive monitoring of immunosuppression. Patients who receive intensified immunosuppression for the treatment of acute rejection are at increased risk for CMV and may require more extended prophylaxis and closer monitoring.
Alissa Kahn, MD1, Andrew Campbell, MD2, Benjamin Shneider, MD3, Betsy Herold, MD4, Birte Wistinghausen, MD1, Gail Shust, MD4, Nanda Kerkar, MD5, Rebecca Madan, MD6, Roberto Posada, MD7, Sukru Emre, MD8 and  R. P. Madan, None., (1)Mount Sinai School of Medicine, (2)Abbott Laboratories, (3)University of Pittsburgh School of Medicine, (4)Mount Sinai School of Medicine, New York, NY, (5)Mt. Sinai Sch. of Med., New York, NY, (6)Albert Einstein College of Medicine, (7)Mount Sinai School of Medicine, New York, NY, N.Y., NY, (8)Yale School of Medicine, New Haven, CT

Dr. Marla Keller received her medical degree from New York University School of Medicine. She completed residency training in Internal Medicine at The Beth Israel Hospital in Boston. She was an Infectious Disease fellow in the Combined Infectious Disease training program at The Beth Israel Hospital, Brigham & Women's Hospital, The Dana Farber Cancer Institute and West Roxbury VA Medical Center in Boston, MA. She has been on faculty at The Mount Sinai School of Medicine as an HIV clinical investigator since 1998. Her major research interest is in the development of safe and effective topical microbicides to prevent HIV and other sexually transmitted infections.

Dr. Marla Keller received her medical degree from New York University School of Medicine. She completed residency training in Internal Medicine at The Beth Israel Hospital in Boston. She was an Infectious Disease fellow in the Combined Infectious Disease training program at The Beth Israel Hospital, Brigham & Women's Hospital, The Dana Farber Cancer Institute and West Roxbury VA Medical Center in Boston, MA. She has been on faculty at The Mount Sinai School of Medicine as an HIV clinical investigator since 1998. Her major research interest is in the development of safe and effective topical microbicides to prevent HIV and other sexually transmitted infections.



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