A. Mellon et al., CYTOMEGALOVIRUS-INFECTION AFTER LIVER-TRANSPLANTATION IN CHILDREN, Journal of gastroenterology and hepatology, 8(6), 1993, pp. 540-544
Post-liver transplant cytomegalovirus (CMV) infection (seroconversion
or virus isolation) and CMV disease (infection plus clinical signs and
symptoms) were studied in relation to pretransplant recipient and don
or serology, age, nutritional status and the effect of paediatric vers
us adult (reduced size) grafts. Of 70 children receiving 79 transplant
s, 26 (37%) had evidence of CMV infection, and eight (11.5%) had evide
nce of CMV disease, four of whom died. The primary infection rate (whe
re the recipients were CMV negative) was 71% with mortality of 7% with
most receiving a CMV-positive graft. The active secondary infection r
ate (reactivation or reinfection, where the recipients were CMV positi
ve) was 60% with mortality of 12.5%. No significant differences in inf
ection or disease rates were found comparing malnourished versus well-
nourished patients, or between those who received whole or reduced-siz
e grafts. The high prevalence of CMV infections supports the view that
clinical signs alone are inadequate to direct investigations for CMV.
Both primary and active secondary CMV infection can result in serious
morbidity and mortality in children receiving liver transplants. Thes
e data do not support the strategy of providing immunoprophylaxis to s
eronegative recipients only, at least in paediatric liver transplantat
ion.