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 Citations (Scopus)

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 - 1991

Fingerprint

Mycoses
Virus Diseases
Human Herpesvirus 4
Candida
Cytomegalovirus
Pediatrics
Ganciclovir
Liver
Morbidity
Hepatitis
Infection
Transplantation
Asymptomatic Infections
Acyclovir
Incidence
Cytomegalovirus Infections
Amphotericin B
Therapeutics
Dialysis
Creatinine

Keywords

  • candida
  • cytomegalovirus
  • Epstein-Barr virus
  • prophylaxis

ASJC Scopus subject areas

  • Immunology
  • Transplantation

Cite this

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.

Prevention and treatment of selected fungal and viral infections in pediatric liver transplant recipients. / Andrews, W.; Siegel, J.; Renard, T.; Megison, S.; Foster, L.; Cushion, N.; Schlatter, M.

In: Clinical Transplantation, Vol. 5, No. 2 II, 1991, p. 204-207.

Research output: Contribution to journalArticle

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, vol. 5, no. 2 II, pp. 204-207.
Andrews, W. ; Siegel, J. ; Renard, T. ; Megison, S. ; Foster, L. ; Cushion, N. ; Schlatter, M. / Prevention and treatment of selected fungal and viral infections in pediatric liver transplant recipients. In: Clinical Transplantation. 1991 ; Vol. 5, No. 2 II. pp. 204-207.
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