Objectives: Cytomegalovirus and Epstein-Barr virus
remain leading causes of morbidity and mortality
in the living-donor liver transplant population,
particularly in pediatric patients. Herein we
compare the incidence, timing, and risk factors for
infection in this group.
Materials and Methods: We performed a
retrospective study of 344 consecutive pediatric
patients 193 women (56.1%) who received livingdonor
liver transplants at Kyoto University Hospital.
Patients were followed-up for maximum 7.1 ± 3.6
years (range, 0.02-13.2 y) after surgery.
Results: The mean age at the time of transplant
was 3.95 ± 4.75 years (median, 1.38 y; range,
0.07-17.87 y). A total of 156 patients (45.2%)
developed viral infections. Of those patients, 91
(26.5%) developed cytomegalovirus infection,
and 93 (27%) developed Epstein-Barr virus.
Cytomegalovirus developed at 39.3 ± 34.6 days,
while Epstein-Barr virus developed 3.99 ± 3.67 years
after transplant. Frequent rejection attacks (hazard
ratio [HR],1.58; 95% confidence interval [CI]: 0.14-2.18; P = .006) were an independent predictor
for postoperative cytomegalovirus infection, while
preoperative cytomegalovirus seropositive results
(HR, 1.76; 95% CI: 1.03-2.18; P = .038), short cold
ischemia time (HR, 1.0; 95% CI: 0.99-1.0; P = .02),
larger graft (HR, 1.3; 95% CI: 1.00-1.73; P = .047), and
new cases compared to old cases (HR, 2.27; 95%
CI: 1.14-4.52; P = .019) were independent predictors
for postoperative Epstein-Barr virus infection.
Conclusions: Extended surveillance of cyto -
megalovirus and Epstein-Barr virus DNAemia is
recommended for pediatric patients receiving livingdonor
liver transplants, particularly infants who are
at high risk, and especially those exposed to
frequent attacks of rejection and those that receive
larger grafts.