Pediatric Transplantation. 2018;e13273. wileyonlinelibrary.com/journal/petr | 1 of 4 https://doi.org/10.1111/petr.13273 © 2018 Wiley Periodicals, Inc. 1 | INTRODUCTION Recent advances in neoadjuvant and adjuvant chemotherapy and surgical techniques, particularly LT, have improved the prognosis of patients with HB. 1-3 However, immunosuppression to prevent or treat allograft rejection often causes opportunistic infections, which are a major cause of morbidity and mortality. 4 CMV infection is the most common viral infection occurring after LT with studies of non-malignant diseases suggesting an incidence of 30%-80%. 5-9 CMV not only causes serious diseases such as pneu- monia, gastroenteritis, retinitis, hepatitis, and encephalitis, but also has indirect effects, including acute/chronic allograft rejection and artery thrombosis, 7,10-12 all of which can negatively affect outcome post-LT. Previous studies report CMV donor and recipient status and use of antithymocyte globulin, anti-CD3 monoclonal antibody, or MMF for ACR as risk factors for CMV infection. 8,11,13 To date, no studies have examined CMV infection in pediatric patients with HB who received pre-LT and/or post-LT chemotherapy and, therefore, might be at increased risk of CMV infection. Here, we Received: 17 December 2017 | Revised: 14 March 2018 | Accepted: 9 July 2018 DOI: 10.1111/petr.13273 ORIGINAL ARTICLE Cytomegalovirus infection in pediatric patients with hepatoblastoma after liver transplantation Seishiro Nodomi 1 | Katsutsugu Umeda 1 | Itaru Kato 1 | Satoshi Saida 1 | Hidefumi Hiramatsu 1 | Eri Ogawa 2 | Atsushi Yoshizawa 2 | Shinya Okamoto 2 | Hideaki Okajima 2 | Shinji Uemoto 2 | Souichi Adachi 3 Abbreviations: ACR, acute cellular rejection; AFP, alpha-fetoprotein; CMV, cytomegalovi- rus; HB, hepatoblastoma; LT, liver transplantation; MMF, mycophenolate mofetil adminis- tration; mPSL, methylprednisolone; N.E., not evaluated; OS, overall survival; PRETEXT, pretreatment extent of disease; TAC, tacrolimus. 1 Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan 2 Pediatric Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan 3 Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan Correspondence: Katsutsugu Umeda, Department of Pediatrics, Graduate School of Medicine, Kyoto University, 54 Kawahara- cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan (umeume@kuhp.kyoto-u.ac.jp). Abstract No studies have examined CMV infection in pediatric patients with HB receiving LT. Here, we retrospectively analyzed the incidence of and risk factors for CMV infec- tion in 24 pediatric patients with HB who underwent LT between 1997 and 2015. CMV infection was monitored by measuring expression of pp65 CMV antigen for up to 4 months post-LT. CMV infection, defined as detection of at least one pp65- positive leukocyte, was detected in nine (37.5%) patients who did not develop CMV disease. Nine (47.4%) of nineteen patients who received post-LT chemotherapy expe- rienced CMV infection; however, no CMV infection was observed in the five patients who did not receive post-LT chemotherapy (P = 0.012). There were no significant differences in the incidence of CMV infection between patients with ACR (60.0%) and those without (21.4%, P = 0.092), or between CMV seropositive (55.6%) and se- ronegative patients (33.3%, P = 0.675). All nine patients with CMV infection did not experience CMV disease due to the use of preemptive antiviral therapy. Close moni- toring of CMV infection is recommended for patients with HB, particularly those re- ceiving post-LT chemotherapy. Preemptive antiviral therapy is feasible for prophylaxis of CMV disease. KEYWORDS cytomegalovirus, hepatoblastoma, liver transplantation, pediatric, preemptive antiviral therapy