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CC BY-NC-ND 4.0 · J Lab Physicians 2018; 10(02): 221-225
DOI: 10.4103/JLP.JLP_140_17
Original Article

Earlier and higher rates of cytomegalovirus infection in pediatric liver transplant recipients as compared to adults: An observational study

Authors

  • Yogita Verma

    Department of Clinical virology, Institute of Liver and Biliary Sciences, New Delhi, India

  • Ekta Gupta

    Department of Clinical virology, Institute of Liver and Biliary Sciences, New Delhi, India

  • Niteen Kumar

    Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India

  • Nadeem Hasnain

    Department of Clinical virology, Institute of Liver and Biliary Sciences, New Delhi, India

  • Ajeet Singh Bhadoria

    Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India

  • Viniyendra Pamecha

    Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India

  • Rajeev Khanna

    Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New, India

Financial support and sponsorship Financial support for the study was provided by Indian Council of Medical Research. Grant number VIR/38/2011/ECD-1.
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ABSTRACT

AIM: To study and compare the incidence and time of occurrence of cytomegalovirus (CMV) infection in the posttransplant period in adult and pediatric liver transplant recipients.

MATERIALS AND METHODS: Consecutive live donor liver transplant recipients not on CMV prophylaxis, were prospectively enrolled from March 2012 to September 2015 and followed up for 1 year post transplant to look for CMV infection. For analysis, patients were divided into pediatric (up to 18 years) and adult (>18 years) age groups.

RESULTS: The study population of 146 patients consisted of 132 adult and 14 pediatric patients. Overall CMV infection posttransplant was seen in 54/146 (36.98%) patients, and 16/54 (29.6%) patients developed CMV disease. Post-transplant CMV infection rate was significantly higher in pediatric patients(10/14 [71.4%]) as compared to adults (44/132 [33.4%]) (P = 0.004). Among adults, CMV infection was seen in 22 (50%) patients in the 1st month, 13 (29.5%) patients in the 2nd month, 5 (11.4%) patients in the 3rd month, 2 (4.5%) patients in the 4th month, and 1 (2.3%) patient each in the 5th and 6th month. However, in pediatric patients, all the patients having CMV infection had it in the 1st-month posttransplant (P = 0.003). The median time of occurrence of CMV infection was 11.5 (7.75–19.00) days in pediatric patients versus 30 (18.5–54.5) days in adult patients (P = 0.001).

CONCLUSIONS: The results of this study show a clear difference in the incidence and timeline of posttransplant CMV infection in pediatric patients as compared to adults.

Keywords

Adults - cytomegalovirus infection - liver transplant - pediatric patients


Publication History

Received: 02 September 2017

Accepted: 18 December 2017

Article published online:
19 February 2020

© 2018.

Thieme Medical and Scientific Publishers Private Ltd.
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  • References

  • 1 Krech U. Complement-fixing antibodies against cytomegalovirus in different parts of the world. Bull World Health Organ 1973;49:103-6.
  • 2 Kothari A, Ramachandran VG, Gupta P, Singh B, Talwar V. Seroprevalence of cytomegalovirus among voluntary blood donors in Delhi, India. J Health Popul Nutr 2002;20:348-51.
  • 3 Razonable RR. Cytomegalovirus infection after liver transplantation: Current concepts and challenges. World J Gastroenterol 2008;14:4849-60.
  • 4 Harvala H, Stewart C, Muller K, Burns S, Marson L, MacGilchrist A, et al. High risk of cytomegalovirus infection following solid organ transplantation despite prophylactic therapy. J Med Virol 2013;85:893-8.
  • 5 Weigand K, Schnitzler P, Schmidt J, Chahoud F, Gotthardt D, Schemmer P, et al. Cytomegalovirus infection after liver transplantation incidence, risks, and benefits of prophylaxis. Transplant Proc 2010;42:2634-41.
  • 6 Marcelin JR, Beam E, Razonable RR. Cytomegalovirus infection in liver transplant recipients: Updates on clinical management. World J Gastroenterol 2014;20:10658-67.
  • 7 Kotton CN, Kumar D, Caliendo AM, Asberg A, Chou S, Danziger-Isakov L, et al. Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation 2013;96:333-60.
  • 8 Lee SO, Razonable RR. Current concepts on cytomegalovirus infection after liver transplantation. World J Hepatol 2010;2:325-36.
  • 9 Arthurs SK, Eid AJ, Pedersen RA, Dierkhising RA, Kremers WK, Patel R, et al. Delayed-onset primary cytomegalovirus disease after liver transplantation. Liver Transpl 2007;13:1703-9.
  • 10 Halasa N, Green M. Immunizations and infectious diseases in pediatric liver transplantation. Liver Transpl 2008;14:1389-99.
  • 11 Green M, Michaels MG. Infections in pediatric solid organ transplant recipients. J Pediatric Infect Dis Soc 2012;1:144-51.
  • 12 Ljungman P, Griffiths P, Paya C. Definitions of cytomegalovirus infection and disease in transplant recipients. Clin Infect Dis 2002;34:1094-7.
  • 13 Bruminhent J, Razonable RR. Management of cytomegalovirus infection and disease in liver transplant recipients. World J Hepatol 2014;6:370-83.
  • 14 Rubin RH. Cytomegalovirus in solid organ transplantation. Transpl Infect Dis 2001;3 Suppl 2:1-5.
  • 15 Kalil AC, Levitsky J, Lyden E, Stoner J, Freifeld AG. Meta-analysis: The efficacy of strategies to prevent organ disease by cytomegalovirus in solid organ transplant recipients. Ann Intern Med 2005;143:870-80.
  • 16 Azevedo LS, Pierrotti LC, Abdala E, Costa SF, Strabelli TM, Campos SV, et al. Cytomegalovirus infection in transplant recipients. Clinics (Sao Paulo) 2015;70:515-23.
  • 17 Breinig MK, Zitelli B, Starzl TE, Ho M. Epstein-barr virus, cytomegalovirus, and other viral infections in children after liver transplantation. J Infect Dis 1987;156:273-9.
  • 18 Verma A, Palaniswamy K, Cremonini G, Heaton N, Dhawan A. Late cytomegalovirus infection in children: High incidence of allograft rejection and hepatitis in donor negative and seropositive liver transplant recipients. Pediatr Transplant 2017;21:e12879. Available from: https://doi.org/10.1111/petr.12879. [Last accessed on 2017 Nov 11].
  • 19 Kotton CN, Kumar D, Caliendo AM, Asberg A, Chou S, Snydman DR, et al. International consensus guidelines on the management of cytomegalovirus in solid organ transplantation. Transplantation 2010;89:779-95.