Prevention and treatment of selected fungal and viral infections in pediatric liver transplant recipients

W. Andrews, J. Siegel, T. Renard, S. Megison, L. Foster, N. Cushion, M. Schlatter

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Infection continues to be a significant cause of morbidity and mortality after transplantation. Three pathogens that cause significant morbidity are Candida, cytomegalovirus, and Epstein-Barr virus. Routine culture of the Roux-En-Y limb at the time of biliary reconstruction, coupled with routine surveillance for Candida colonization, identified a group of children at risk for candida sepsis. With positive cultures, 7- to 10-day courses of amphotericin B decreased the incidence of symptomatic and asymptomatic Candida infection by 50%. Epstein-Barr virus (EBV) remains a difficult infection to detect. EBV hepatitis is a diagnosis of exclusion. Epstein-Barr virus hepatitis is often initially treated as rejection (100%), can relapse (40%), and can result in graft loss (20%). Treatment with high-dose intravenous acyclovir (45 mg/kg/day) can resolve the infection in 57% of cases. Cytomegalovirus (CMV) continues to be a major cause of morbidity after transplantation. The use of prophylactic i.v. IgG decreased the incidence of asymptomatic and symptomatic CMV infection by 50%. Symptomatic CMV disease can be successfully treated with intravenous ganciclovir with 87% survival. Ganciclovir caused minimal bone marrow suppression in this series; however, 75% of children treated exhibited at least a doubling of their creatinine during therapy, and necessitated dialysis in l patient. Renal function returned to normal in all patients after treatment was stopped.

Original languageEnglish (US)
Pages (from-to)204-207
Number of pages4
JournalClinical Transplantation
Volume5
Issue number2 II
StatePublished - Jan 1 1991

Keywords

  • Epstein-Barr virus
  • candida
  • cytomegalovirus
  • prophylaxis

ASJC Scopus subject areas

  • Transplantation

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    Andrews, W., Siegel, J., Renard, T., Megison, S., Foster, L., Cushion, N., & Schlatter, M. (1991). Prevention and treatment of selected fungal and viral infections in pediatric liver transplant recipients. Clinical Transplantation, 5(2 II), 204-207.