Cytomegalovirus infection in liver-transplanted children

Abstract

Cytomegalovirus (CMV) infection is a common complication of liver trans-plantation in children. The CMV serostatus of recipients and donors is the primary risk factor, and prophylaxis or pre-emptive strategies are recommended for high-risk patients. Graft rejection, coinfection and Epstein-Bar virus reactivation, which can lead to post-transplant lymphoproliferative disease, are indirect effects of CMV infection. Assessment of CMV infection viral load should be routinely performed upon clinical suspicion. However, tissue-invasive CMV disease is not associated with CMV viraemia and requires confirmation by tissue pathology. Oral valganciclovir and intravenous ganciclovir are equivalent treatments, and the duration of treatment depends on factors including CMV viral load, tissue pathology, and clinical response. Risk stratification by donor and recipient status prior to transplantation and post-transplantation antiviral prophylaxis or pre-emptive therapy are recommended. Adult guidelines have been established but additional study of the effectiveness of the preventive guidelines in children is needed. This review summarizes the burden, risk factors, clinical manifestations, laboratory evaluation, treatment, and prevention of CMV infection in children after liver transplantation.

Decoding the Landscape of Cytomegalovirus Research in Liver Transplantation: An In-Depth Analysis

“…This progress has been driven by extensive research efforts and the introduction of innovative pharmaceuticals that specifically target different phases of the CMV replication process, moving away from conventional antiviral agents. 7,11,13, 21,22 The in- corporation of modern methodologies, accompanied by customized therapeutic strategies informed by pharmacogenomic knowledge, holds the potential to revolutionize the care of liver transplant recipients with CMV infection, enhance patient outcomes and reduce the occurrence of related complications. 6 Given the critical importance of these interventions in clinical practice, it is not surprising that "prevention" and "prophylaxis" rank among the most frequently occurring keywords in the literature on this topic.…”

A quick algorithmic review on management of viral infectious diseases in pediatric solid organ transplant recipients

“…In patients with reliable gastrointestinal absorption, oral valganciclovir is preferred for mild to moderate CMV disease or asymptomatic CMV infection ( 22 ). However, in the situations of severe or life-threatening CMV disease, very high viral load and tissue-invasive CMV disease, intravenous ganciclovir is recommended to rapidly achieve optimal drug levels.…”

“…A dosing algorithm based on body surface area (BSA) and kidney function is recommended for valganciclovir ( 23 ). Patient's monitoring during antiviral therapy includes complete blood counts to check for hematologic side effects, kidney function assessments to determine antiviral dose adjustment, and weekly quantitative CMV PCR to assess medication response ( 22 ). Antiviral therapy should be continued as long as all three following conditions are met ( 17 ): Clinical symptoms subside.…”

Pediatric Liver Transplantation: Long-Term Follow-Up Issues

“…The CMV serology of the donor-recipient pair is the main risk factor; therefore, antiviral prophylaxis according to risk stratification or instead preemptive therapy is recommended (Table 2). 62 Furthermore, graft rejection is often a consequence of CMV infection; EBV coinfection or reactivation can have detrimental consequences, potentially leading to PTLD. 63 Assessment of the CMV infection viral load should be routinely performed when there is clinical suspicion.…”