Cytomegalovirus prophylaxis in pediatric liver transplantation: A comparison of strategies across the Society of Pediatric Liver Transplantation (SPLIT) consortium

Knackstedt ED, Anderson SG, Anand R, Mitchell J, Arnon R, Book L, Ekong U, Elisofon SA, Furuya KN, Himes R, Jain AK, Ovchinsky N, Sundaram SS, Bucuvalas J, Danziger-Isakov L

Although cytomegalovirus (CMV) is a common complication after pediatric liver transplantation (PLT), the optimal method for CMV prevention is uncertain and lacks multicentered investigation. We compared the effectiveness of short (<120 days) vs long (>180 days) CMV primary antiviral prophylaxis to prevent CMV disease in PLT, through a prospective cohort study of primary PLT (aged <18 years) recipients enrolled in the Society of Pediatric Liver Transplantation registry from 2015 to 2019 with either donor or recipient CMV seropositivity. Participants were grouped into short or long prophylaxis based on their center's practice and intended duration. In total, 199 PLT recipients were enrolled including 112 (56.3%) short and 87 (43.7%) long prophylaxis. End-organ disease was rare and similar between groups (2.7% and 1.1%; P 1/4 .45). CMV DNAemia and syndrome were more common in the short compared with those in long prophylaxis (26.8% vs 13.8%; P 1/4 .03; 18.8% vs 6.9%; P 1/4 .02). Neutropenia occurred more commonly with long prophylaxis (55.2% vs 16.1%; P < .001). Graft and patient survival were similar. Consideration of a short prophylaxis must weigh increased risk of CMV syndrome/DNAemia against medication burden and neutropenia of longer prophylaxis.

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