Cytomegalovirus DNAemia After Pediatric Liver Transplantation: Clinical Characteristics, Risk Factors, and Outcomes.

Authors

Gül Arga, Zarife Kuloglu, Elif Somuncu, Ceyda Tuna Kirsaçlioğlu, Halil Özdemir, Arzu Meltem Demir, Hülya Akat, Kübra Arslan, Serpil Özdemir, İlkin Elif Günel Karaburun, Merve Havan, Meltem Koloğlu, Elvan Onur Kirimker, Tanil Kendirli, Aydan Kansu, Ergin Çiftçi

Published in

The Pediatric infectious disease journal. Oct 06, 2026. Epub Oct 06, 2026.

Abstract

Cytomegalovirus (CMV) remains a frequent infectious complication after pediatric liver transplantation despite antiviral prophylaxis. However, the clinical significance of CMV DNAemia and predictors of treatment-requiring CMV DNAemia remain incompletely defined. We evaluated the epidemiology, timing, clinical characteristics and predictors of CMV DNAemia in pediatric liver transplant recipients managed with a hybrid prevention strategy.
We conducted a retrospective cohort study of consecutive pediatric liver transplant recipients who underwent transplantation between 2014 and 2025 at a tertiary center. CMV DNAemia was identified through routine quantitative polymerase chain reaction surveillance during antiviral prophylaxis and the subsequent preemptive monitoring period. Treatment-requiring CMV DNAemia was defined as CMV DNAemia prompting antiviral therapy based on viral load kinetics, absolute viral load and accompanying clinical findings. Demographic, transplant-related, clinical and virological factors were analyzed.
Fifty-one recipients were included. CMV DNAemia developed in 35 recipients (68.6%), accounting for 77 episodes. Breakthrough CMV DNAemia occurred in 22 recipients (62.8%), whereas 13 developed CMV DNAemia only after prophylaxis discontinuation. Twenty-eight episodes occurred during prophylaxis, but only 7 (25.0%) required treatment. Overall, 15 recipients experienced 25 treatment-requiring episodes, representing 32.5% of all CMV DNAemia episodes; 72% occurred after prophylaxis discontinuation. No patient developed tissue-invasive CMV disease. Younger age at transplantation (OR: 0.979; 95% CI: 0.963-0.995; P = 0.013) and pretransplant intensive care unit requirement (OR: 7.75; 95% CI: 1.44-41.84; P = 0.017) independently predicted treatment-requiring CMV DNAemia. An age threshold of ≤26 months showed acceptable discrimination (area under the curve, 0.773) and was associated with lower CMV-free survival (P < 0.001).
CMV DNAemia was common, but only one-third of episodes required antiviral treatment, and no tissue-invasive disease occurred. Younger recipients and those requiring pretransplant intensive care were at increased risk for clinically significant CMV infection. CMV DNAemia alone should not be considered a surrogate for clinically significant infection, supporting individualized, risk-adapted surveillance and prevention in pediatric liver transplant recipients.

PMID:
42837144
Bibliographic data and abstract were imported from PubMed on 07 Oct 2026.

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