IMMUNOLOGICAL ASPECTS OF CYTOMEGALOVIRAL INFECTIONS AFTER PEDIATRIC LIVER TRANSPLANTATION
N.Zh. Erimova, Sh.K. Batyrkhanov, B.K. Shirtaev, B.B. Baimakhanov, A.T. Chormanov, S.D. Akilbekov, A.G. Akhbetova
The article reflects the role of antiviral prophylaxis with valganciclovir or ganciclovir after pediatric liver transplantation. The study was conducted on the basis of data from thirty operations, in children from 6 months to 8 years. All patients of our center with cytomegalovirus infection (CMV) received antiviral therapy for a month. In patients with active CMV, the viral load was reduced. Six months later, the quantitative polymerase chain reaction (PCR) for CMV became negative in all patients. After nine (9) months, viral load increased in 1 (3.3%) patient with inactive CMV. After 12 (twelve) months, viremia was diagnosed in 6 (20%) patients and they were prescribed antiviral therapy for 3-6 months with valganciclovir. A decrease in the total number of T-lymphocytes and T-helpers was noted against the background of phylactic suppressive therapy and viremia (8 patients).
Purpose : The purpose of this work is to assess the role of CMV infection in transplant immunology in children and the effect of CMV on the outcome of liver transplantation.
Materials and methods .
Place of research: JSC “NSCH named after A.N. Syzganov”.
Subject of research: Pediatric patients with liver cirrhosis.
Study duration: from March 2016 to the present day.
Study design: Randomized controlled trial.
Research protocol: Since March 2016, 30 (30) surgical operations for liver transplantation have been performed in children using materials taken from living donor relatives. Patient age: from 6 months to 8 years, of which: 23 (76.6%) patients - biliary atresia; 2 (6.9%) patients - liver cirrhosis as a result of autoimmune hepatitis; 1 (3.3%) patient - primary hyperoxaluria; 1 (3.3%) patient - cholangiocarcinoma; 1 (3.3%) patient - inoperable hepatoblastoma; 1 (3.3%) Liver cirrhosis in the outcome of viral hepatitis "C" against the background of histiocytosis of Langerhans cells. The number of female newborns - 17 (56.7%) patients, male babies - 13 (43.3%) patients.
All patients with positive quantitative PCR before surgery took cytomegalovirus immunoglobulin for 3-5 days. The left lateral sector was transplanted to 23 (76.6%) patients with biliary atresia from their CMV seropositive relative (D + / R +) and 4 (23.3%) patients from their CMV seronegative donors (D - / R +).
Clinical laboratory and instrumental research methods: In order to assess the immunological status of children, the results of immunograms, hemograms with leukoformula were used. By electrochemiluminescent immunoassay from venous and capillary blood, IgM, IgG antibodies, and the avidity of antibodies to cytomegalovirus were determined.
Methods stat. Analysis: Statistical processing of digital values was carried out using standard methods of statistical analysis used in biomedical research, using a software package for personal computers: Microsoft Office Excel, StatisticaStatSoft. All pediatric liver transplants from March 2016 to the present day have been counted.
Ethical issues: The study was conducted in accordance with the current version of the Declaration of Helsinki, in accordance with the Standard of Good Clinical Practice (GCP) (Appendix 2 to the order of the Acting Minister of Health of the Republic of Kazakhstan dated February 4, 2021 No. ҚР DSM-15) .
Results. The total number of seropositive donors (D + / R +) is 26 (86.6%). The total number of seronegative donors (D- / R +) is 4 (13.4%). One concurrent liver and kidney transplant was performed in one infant patient. All patients with biliary atresia had CMV infection (CMVI). Eight (8) patients had active disease. Follow-up period: 14 days - 3 years after liver transplantation.
Key words: liver transplantation, cytomegalovirus infection, pediatric transplantation.