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 (odds ratio, 17.23; 95% confidence interval, 1.88-157.87; P = 0.012), while viremia per se did not worsen LT outcomes, such as the incidence of acute rejection, Epstein-Barr virus 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 days vs 38.6 ± 14 days, P < 0.0001) and cost per patient (2.2 ± 3.9 k€ 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.

Nicastro, E., Giovannozzi, S., Stroppa, P., Casotti, V., Callegaro, A., Tebaldi, A., et al. (2017). Effectiveness of Preemptive Therapy for Cytomegalovirus Disease in Pediatric Liver Transplantation. TRANSPLANTATION, 101(4), 804-810 [10.1097/TP.0000000000001531].

Effectiveness of Preemptive Therapy for Cytomegalovirus Disease in Pediatric Liver Transplantation

Colledan M;D'Antiga L
2017

Abstract

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 (odds ratio, 17.23; 95% confidence interval, 1.88-157.87; P = 0.012), while viremia per se did not worsen LT outcomes, such as the incidence of acute rejection, Epstein-Barr virus 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 days vs 38.6 ± 14 days, P < 0.0001) and cost per patient (2.2 ± 3.9 k€ 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.
Articolo in rivista - Articolo scientifico
Adolescent; Age Factors; Antiviral Agents; Chi-Square Distribution; Child; Child, Preschool; Cost Savings; Cost-Benefit Analysis; Cytomegalovirus Infections; Drug Administration Schedule; Drug Costs; Female; Ganciclovir; Humans; Infant; Italy; Kaplan-Meier Estimate; Liver Transplantation; Male; Odds Ratio; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome
English
2017
101
4
804
810
reserved
Nicastro, E., Giovannozzi, S., Stroppa, P., Casotti, V., Callegaro, A., Tebaldi, A., et al. (2017). Effectiveness of Preemptive Therapy for Cytomegalovirus Disease in Pediatric Liver Transplantation. TRANSPLANTATION, 101(4), 804-810 [10.1097/TP.0000000000001531].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/332237
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