Preliminary clinical experience applying donor-derived cell-free DNA to discern rejection in pediatric liver transplant recipients

AbstractDonor-derived cell-free DNA (dd-cfDNA) has been of major interest recently as a non-invasive marker of graft injury, but has not yet been extensively tested in children. From May to September in 2019, a total of 76 pediatric patients receiving a liver graft were enrolled and there were 27 patients excluded. Ultimately plasma samples and matched liver specimens from 49 patients were successfully collected whenever rejection was suspected clinically. Dd-cfDNA were analyzed and then compared to biopsy. Of these, 11 (22.4%) patients were found to have rejection by biopsy. Dd-cfDNA levels were higher among patients with rejection compared to those with no rejection. In subgroup analysis, dd-cfDNA% among patients with rejection differed from those with EBV/CMV infection and DILI patients. Similarly, observations were available concerning dd-cfDNA (cp/mL). The AUC for dd-cfDNA% and dd-cfDNA (cp/mL) were 0.878, 0.841, respectively, both of which were higher than conventional LFTs. For rejection, dd-cfDNA% ≥ 28.7% yielded a sensitivity of 72.7%, specificity 94.7% and dd-cfDNA (cp/mL) ≥ 2076 cp/mL, yielded a sensitivity of 81.8%, specificity 81.9%. Of note, the dd-cfDNA distribution was significantly different between whole liver and LLS transplantation. In the setting of pediatric LTx, dd-cfDNA appears to be a sensitive biomarker indicating the presence of rejection.International Clinical Trails Registry Platform: ChiCTR1900022406.

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The impact of chronic Epstein–Barr virus infection on the liver graft of pediatric liver transplant recipients: A retrospective observational study

Transplant Infectious Disease ◽

10.1111/tid.13731 ◽

2021 ◽

Author(s):

Masato Shizuku ◽

Hideya Kamei ◽

Atsushi Yoshizawa ◽

Yoshinori Ito ◽

Yasuhiro Ogura ◽

...

Keyword(s):

Epstein Barr Virus ◽

Liver Graft ◽

Epstein Barr Virus Infection ◽

Transplant Recipients ◽

Barr Virus ◽

Epstein Barr ◽

Barr Virus Infection ◽

Liver Transplant Recipients ◽

The Impact ◽

Pediatric Liver Transplant

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The use of transient elastography and non-invasive serum markers of fibrosis in pediatric liver transplant recipients

Pediatric Transplantation ◽

10.1111/petr.12116 ◽

2013 ◽

Vol 17 (6) ◽

pp. 525-534 ◽

Cited By ~ 24

Author(s):

Imeke Goldschmidt ◽

Henrik Stieghorst ◽

Mona Munteanu ◽

Thierry Poynard ◽

Jerome Schlue ◽

...

Keyword(s):

Liver Transplant ◽

Transient Elastography ◽

Serum Markers ◽

Transplant Recipients ◽

Non Invasive ◽

Pediatric Liver ◽

Liver Transplant Recipients ◽

Pediatric Liver Transplant

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CLINICAL SIGNIFICANCE OF CYTOMEGALOVIRUS INFECTION IN PEDIATRIC LIVER TRANSPLANT RECIPIENTS

Russian Journal of Transplantology and Artificial Organs ◽

10.15825/1995-1191-2016-1-67-77 ◽

2016 ◽

Vol 18 (1) ◽

pp. 67-77 ◽

Cited By ~ 1

Author(s):

O. M. Tsiroulnikova ◽

I. V. Zhilkin ◽

D. G. Akhaladze

Keyword(s):

Liver Transplantation ◽

Liver Transplant ◽

Graft Loss ◽

Transplant Recipients ◽

Cmv Infection ◽

Pediatric Liver ◽

Life Saving ◽

End Stage ◽

Liver Transplant Recipients ◽

Pediatric Liver Transplant

Liver transplantation is a life-saving procedure for many forms of end-stage liver disease in pediatrics. Cytomegalovirus (CMV) is the most common and signifi cant posttransplant infection after pediatric liver transplant (PLT) with developing an episode of CMV infection or disease. It is well known that CMV increases risk of graft loss. The review presents aspects of etiology and epidemiology of CMV after PLT, approaches employed in diagnostics and prophylaxis of CMV, algorithms for valganciclovir dosing and methods to prevent complications associated with CMV. The latest data on current prevention strategies in pediatric liver transplantation centers in the world are also presented.

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Earlier and higher rates of cytomegalovirus infection in pediatric liver transplant recipients as compared to adults: An observational study

Journal of Laboratory Physicians ◽

10.4103/jlp.jlp_140_17 ◽

2018 ◽

Vol 10 (02) ◽

pp. 221-225 ◽

Cited By ~ 1

Author(s):

Yogita Verma ◽

Ekta Gupta ◽

Niteen Kumar ◽

Nadeem Hasnain ◽

Ajeet Singh Bhadoria ◽

...

Keyword(s):

Liver Transplant ◽

Pediatric Patients ◽

Transplant Recipients ◽

Cmv Infection ◽

Live Donor Liver Transplant ◽

Post Transplant ◽

Pediatric Liver ◽

Live Donor Liver ◽

Liver Transplant Recipients ◽

Pediatric Liver Transplant

ABSTRACT AIM: To study and compare the incidence and time of occurrence of cytomegalovirus (CMV) infection in the posttransplant period in adult and pediatric liver transplant recipients. MATERIALS AND METHODS: Consecutive live donor liver transplant recipients not on CMV prophylaxis, were prospectively enrolled from March 2012 to September 2015 and followed up for 1 year post transplant to look for CMV infection. For analysis, patients were divided into pediatric (up to 18 years) and adult (>18 years) age groups. RESULTS: The study population of 146 patients consisted of 132 adult and 14 pediatric patients. Overall CMV infection posttransplant was seen in 54/146 (36.98%) patients, and 16/54 (29.6%) patients developed CMV disease. Post-transplant CMV infection rate was significantly higher in pediatric patients(10/14 [71.4%]) as compared to adults (44/132 [33.4%]) (P = 0.004). Among adults, CMV infection was seen in 22 (50%) patients in the 1st month, 13 (29.5%) patients in the 2nd month, 5 (11.4%) patients in the 3rd month, 2 (4.5%) patients in the 4th month, and 1 (2.3%) patient each in the 5th and 6th month. However, in pediatric patients, all the patients having CMV infection had it in the 1st-month posttransplant (P = 0.003). The median time of occurrence of CMV infection was 11.5 (7.75–19.00) days in pediatric patients versus 30 (18.5–54.5) days in adult patients (P = 0.001). CONCLUSIONS: The results of this study show a clear difference in the incidence and timeline of posttransplant CMV infection in pediatric patients as compared to adults.

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