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.
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