1084 - Epidemiology and Long-term Outcomes of Cytomegalovirus (CMV) in Pediatric Liver Transplant Recipients (PLTR) at Texas Children’s Hospital (TCH)

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Presenting Author(s)

Kristen G. Valencia Deray

Assistant Professor
Baylor College of Medicine/Texas Children's Hospital
Houston, Texas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

KH

Kathleen Hosek

Ms
Texas Children's Hospital
Houston, Texas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Flor M. Munoz

Associate Professor of Pediatrics
Baylor College of Medicine
Houston, TX
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Elizabeth A. Moulton

Assistant Professor of Pediatrics
Baylor College of Medicine/Texas Children's Hospital
Houston, Texas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
GD

Gail J. Demmler-Harrison

Professor
Baylor College of Medicine
Bellaire, Texas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DL

Daniel H. Leung

Associate Professor/Director of Hepatology and Liver Transplant Medicine
Baylor College of Medicine/Texas Children's Hospital
Houston, Texas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CB

Claire Bocchini

Assistant Professor of Pediatrics
Baylor College of Medicine
Houston, Texas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Despite widespread use of prevention strategies, CMV DNAemia remains common in PLTR. Contemporary data, however, is limited. We sought to determine the frequency of, risk factors for, and long term outcomes of CMV DNAemia in a large, single center cohort of PLTR.

Methods: A retrospective cohort study of PLTR < 22 yrs of age transplanted from 2011-2018 was completed. Per protocol, CMV prophylaxis with ganciclovir/valganciclovir was universally implemented; high risk (HR)(D+/R-) and intermediate risk (IR)(R+) patients received 6 months while low risk (LR)(D-/R-) patients received 3 months. Primary outcomes included any CMV DNAemia, CMV DNAemia >1000 IU/mL and long term outcomes including rejection, graft failure, hepatic steatosis (HS), and de novo autoimmune hepatitis (AIH). Associations with CMV DNAemia were measured using Fisher exact and multivariate regression. Survival analysis, time to CMV infection, and time to PLTR long term outcomes were assessed using Kaplan-Meier plots.

Results: Among 270 PLTR, 81 (30%) had quantifiable CMV DNAemia; 36 (13%) had CMV DNAemia >1000 IU/mL. Fifty (19%) developed CMV DNAemia while on prophylaxis. Median time (range) to CMV DNAemia was 162 days (5-2213). HR (OR 4.18; 95% CI 1.84-9.49, p< 0.01) status was associated with CMV DNAemia and time to CMV DNAemia. CMV DNAemia was not associated with age at transplantation or cold ischemic time.
Eight PLTR (3%) developed CMV syndrome (4 HR, 3 IR, 1 LR), the median peak (range) DNAemia was 2133 IU/mL (202-58000) for these patients. No PLTR developed CMV tissue invasive disease.

CMV DNAemia was not associated with rejection (15% vs. 33%, p=0.62), graft failure (7% vs. 13%, p=0.17), HS (8% vs. 12%, p=0.32), or AIH (10% vs. 8%, p= 0.68). CMV DNAemia was associated with a longer time to rejection (p=0.02). Time to development of graft failure, HS, and AIH were not associated with CMV DNAemia (Figure 1). Finally, there was no difference in survival during the study follow-up period (1 – 9 yrs) for PLTR with vs. without CMV DNAemia (p=0.58).Figure 1

Conclusion: This large cohort of PLTR demonstrates high rates of CMV DNAemia but low rates of CMV disease. HR status remains associated with CMV DNAemia. CMV DNAemia did not increase the risk of long term adverse outcomes such as rejection, graft failure, HS, and AIH.