Cytomegalovirus infections in pediatric liver transplantation
S. M. King, M. Petric, R. Superina, N. Graham and E. A. Roberts
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
From 1986 to 1989, 26 consecutive pediatric liver transplant recipients
were followed up at The Hospital for Sick Children, Toronto, Canada. The
patients were reviewed to assess the incidence of infection with
cytomegalovirus, the severity of disease, and the relationship of recipient
and donor serostatus to cytomegalovirus disease. Overall, the incidence of
infection was 54% (14/26). Over 90% of patients who were seropositive or
whose donors were seropositive developed evidence of cytomegalovirus
infection after transplantation. Forty-three percent (6/14) of those with
cytomegalovirus infections developed severe, fatal cytomegalovirus disease,
despite treatment with immunoglobulins and ganciclovir (Syntex Laboratories
Inc, Palo Alto, Calif) or foscarnet sodium (Astra, Pharmaceutical Products
Inc, Westborough, Mass). Of all posttransplant deaths, two thirds were
associated with severe cytomegalovirus infection. Cytomegalovirus-related
deaths occurred in three of four seronegative patients with seropositive
donors and three of six seropositive patients with seropositive donors.
Therefore, a seropositive donor appeared to be a major risk factor for
severe cytomegalovirus disease.
