CMV DNAemia Common After Pediatric Liver Transplantation, but Most Episodes Untreated

A retrospective cohort study in The Pediatric Infectious Disease Journal evaluated CMV DNAemia in 51 consecutive pediatric liver transplant recipients transplanted between 2014 and 2025 at a tertiary center. Recipients underwent quantitative PCR surveillance during antiviral prophylaxis and subsequent preemptive monitoring. Treatment-requiring DNAemia was defined by initiation of antiviral therapy based on viral load, viral kinetics and accompanying clinical findings.

CMV DNAemia developed in 35 recipients (68.6%), comprising 77 episodes. Of 28 episodes occurring during prophylaxis, seven (25.0%) required treatment. Overall, 15 recipients experienced 25 treatment-requiring episodes, representing 32.5% of all episodes; 72% occurred after prophylaxis discontinuation. No recipient developed tissue-invasive CMV disease.

Younger age at transplantation was independently associated with treatment-requiring DNAemia (OR, 0.979; 95% CI, 0.963–0.995), as was pretransplant intensive care requirement (OR, 7.75; 95% CI, 1.44–41.84). An age threshold of 26 months or younger had an area under the curve of 0.773 and was associated with lower CMV-free survival.

The findings distinguish detectable CMV DNAemia from infection prompting treatment and support consideration of risk-adapted surveillance. However, the small, single-center retrospective cohort and wide confidence interval for intensive care requirement limit generalizability and precision. The treatment endpoint reflected clinical decisions rather than tissue-invasive disease, and the study does not establish an optimal prevention strategy.