A Retrospective Clinical Study and Analysis of Cytomegalovirus and Epstein-Barr Virus Infection and Disease in Pediatric Liver Transplant Recipients
Date
2017-06-26
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Abstract
Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) are two ubiquitous Herpesviruses that are a significant cause of morbidity and mortality in immunocompromised patients (Britt 2008; Cohen 2000). In transplant recipients, they can cause severe end-stage viral disease that manifests as multiple-system organ failure or post-transplant lymphoproliferative disorder (Britt 2008; Cohen
2000). Currently, there is a significant gap in the literature for these infections in the context of pediatric patients. Thus, current protocols are extrapolated from adult medicine, dependent on inadequate studies, or based on theories derived from virology and transplant immunology (Gans, H., Chen, S. 2016). Given this significant lack in evidence-based medicine, a team of Infectious Disease physicians at Stanford University Medical Center (SUMC) and I set out to begin to provide evidence for SUMC’s clinical practice guidelines. We also aimed to develop risk factor stratification for CMV and EBV outcomes, determine the role that CMV and EBV infection plays in the development of disease, and identify an effective prophylaxis protocol. I conducted a ten-year retrospective clinical study performing chart reviews on solid organ transplant recipients and storing relevant information in a secure database. For this thesis, I will be focusing on risk factor stratification in liver transplant recipients only. Utilizing the data I have collected and conducting robust statistical analysis, I hypothesize that donor serology pre-transplant plays a significant role in the development of disease post-transplant. Other risk factors such as rejection do not seem to be directly involved in the development of end-stage viral disease. This study has verified some hypothesized virologic interactions and provided evidence illustrating that other risk factors may be less integral to the development of disease than previously thought. The results of this study will not only be used to develop a new transplant protocol at SUMC, but also to encourage other physicians to pursue the development of evidence-based clinical guidelines to minimize the prevalence of needless and preventable suffering.
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Epstein-Barr Virus, Cytomegalovirus, Epstein-Barr Virus, Transplant, Pediatrics, Clinical Research