Cytomegalovirus and epstein-barr virus infection and disease

Epstein-Barr virus (EBV) and cytomegalovirus (CMV) infections represent the two main infectious threats following paediatric liver transplantation. In particular, EBV primary infection is observed in 60–80% of seronegative children within 3 months of solid organ transplant, either from the oropharyngeal route or via donor passenger lymphocytes in the transplanted organ from a seropositive donor. Symptomatic EBV infection occurs in 8–22% of the cases and its most threatening complication, post-transplant lymphoproliferative disease (PTLD), in about 5% of all paediatric liver transplant recipients. PTLD is a potentially fatal condition that requires aggressive diagnostic approach and multidisciplinary management. In this chapter we present a tactic to treat PTLD through a clinical algorithm, based on stratification according to the disease risk. CMV infection, in the absence of preventative measures, and similarly to EBV, depends mostly on the serological donor and recipient status and the type of immunosuppression. CMV infection in most cases has an asymptomatic course. However, about 20–30% of the infected patients develop a CMV disease that can affect various organs, including the graft. Like EBV, CMV infection in LT recipients is monitored by the detection of the DNA in blood or serum. Ganciclovir, an antiviral agent, is very effective on CMV, whereas it does not provide benefits in EBV-infected patients. The goal of the anti-CMV management is to prevent overt disease and related complications. To achieve this result, two major strategies are currently employed, prophylaxis and preemptive therapy, but the latter offers the advantages of similar efficacy, less antiviral use, shorter length of hospitalisation and overall lower costs.