Journal Article

Efficacia della terapia preemptive per il citomegalovirus nel trapianto di fegato pediatrico

Tebaldi, Alessandra, Lorenzo D’Antiga, Nicastro, Emanuele, Callegaro, Anna Paola, Casotti, Valeria, Tulone, Anna, Colledan, Michele, Giovannozzi, Sara, Stroppa, Paola, Farina, Claudio

2017

Overview

Background. Most pediatric liver transplantation (LT) centers administer long courses of prophylaxis against cytomegalovirus (CMV) without evidence of benefit and with significant drug exposure and costs. We aimed at evaluating overall outcomes, direct and putative indirect effects of CMV, possible impact of viremia and risk factors for CMV infection in pediatric LT recipients managed with ganciclovir-based preemptive therapy (PET).Methods. The records of all the children who underwent LT between 2008 and 2014 were retrospectively analyzed.Results. One-hundred children were included. Three children had CMV disease; no CMV-related death or graft loss was recorded. The only identified risk factor for CMV infection was the donor/recipient serostatus [OR: 17.23 (95%CI: 1.88-157.87); P=0.012], while viremia per se did not worsen LT outcomes, such as the incidence of acute rejection, EBV infection, sepsis, biliary and vascular complications, nor graft dysfunction/loss or death at 3 and 5 years after LT. When compared with a historical cohort of children receiving ganciclovir prophylaxis, PET did not differ from prophylaxis for any of the selected outcomes, but was rather associated with lower antiviral drug exposure (6.4 ± 13 vs 38.6 ± 14 days, P < 0.0001) and cost per patient (2.2 ± 3.9 vs 6.6 ± 8.2 k€, P = 0.001).Conclusions. PET is effective in controlling CMV in children receiving LT, with lower costs and lower exposure to antivirals.

• Publisher: Pensiero Scientifico Editore
• Subject: Cytomegalovirus / Disease prevention / Infections / Liver transplants / Pediatrics