Cytomegalovirus Infections

After transplantation, primary cytomegalovirus (CMV) infection may develop in seronegative recipients or reactivation can occur in seropositive recipients. Clinical diagnosis of  CMV disease is suggested by the development of fever, malaise, arthralgies, leukopenia, maculo-papular rush, altered liver tests, respiratory insufficiency or gastrointestinal hemorrhages.
Incidence and severity of infection are related to the preoperative CMV status of the transplant donor and recipient; CMV disease occurs mostly when a CMV negative recipient receives a graft from a CMV positive donor. To prevent CMV infection, Ganciclovir prophylaxis has been successfully used.
Recently, direct CMV antigen quantification in circulating polymorphonucleated cells (pp65) has been introduced to diagnose and treat CMV infection early.
In our series of 97 pediatric liver recipients, 47 were CMV positive (48%), transplanted  with 44 (94%) graft from CMV positive donors and 3 (6%) graft from CMV negative donors. The remaining 50 recipients (52%) were CMV negative and received 39 (78%) graft from CMV positive donors and 11 (22%) from CMV negative donors. We used ganciclovir prophylaxis in high risk seronegative patients receiving graft from seropositive donors, while monitoring of pp65 and preemptive therapy was used in all the other recipients.
The overall incidence of CVM infection was 24%, occurring at a mean of 40 days after liver transplantation. In only three high risk patients symptomatic disease occurred. No CMV-related death occurred.