Efficacy and safety of valganciclovir in liver-transplanted children infected with Epstein-Barr virus.

Epstein-Barr virus (EBV) infection after liver transplantation (LT) is associated with increased risk of posttransplant lymphoproliferative disorder (PTLD). Lowering immunosuppression is the current method to prevent PTLD in LT children with a high viral load. The aim of this study was to assess the efficacy and safety of valganciclovir (VGCV) in children with EBV infection after LT. Forty-seven children showing detectable EBV-DNA (72% asymptomatic) were treated with VGCV (520 mg/sqm twice daily) with no immunosuppression decrease (except in 4 cases). VGCV treatment started 17 months (median) after the onset of EBV infection. A 30-day treatment applied to 26 patients led to undetectable EBV-DNA in 11/32 courses (34.3%), with 82% relapsing. A long VGCV treatment (median: 8 months) achieved undetectable EBV-DNA in 20/42 (47.6%), 60% of whom maintained response off therapy. There were no new PTLD cases. Symptoms worsened in 1 (2.1%) in whom PTLD was suspected but not confirmed in liver and jejunum biopsies. Factors associated with achievement of undetectable EBV-DNA were a longer time from LT and a lower rate of intervening infections in comparison with nonresponders. The safety profile for VGCV was excellent. Graft rejection occurred in 6%. In conclusion, in 47 LT children with a sustained increased EBV load treated with VGCV and unchanged immunosuppression, PTLD was suspected in 1 child (2.1%). A viral load decrease could be achieved as EBV-DNA was undetectable in 47% of patients under prolonged treatment.

Efficacy and safety of peginterferon-alpha2b and ribavirin combination therapy in children with chronic hepatitis C infection.

BACKGROUND: Interferon (IFN)-alpha2b plus ribavirin is approved for treatment of hepatitis C in children; however, little is known about efficacy and tolerability of pegylated IFN (PEG-IFN)-alpha2b in this population. The objective of this study was to test the efficacy and safety of PEG-IFN-alpha2b plus ribavirin in children with chronic hepatitis C. METHODS: Thirty children 3-16 years of age who had detectable hepatitis C virus (HCV) RNA for >or=3 years after exposure and elevated alanine aminotransferase values received PEG-IFN-alpha2b 1.0 microg/kg/wk plus ribavirin 15 mg/kg/d for 24 weeks (genotype 2/3) or 48 weeks (genotype 1/4). The primary endpoint was sustained virologic response (SVR), defined as undetectable HCV RNA (<50 IU/mL) at week 24 of follow-up. RESULTS: SVR was achieved in 50% of patients (3/3 genotype 3; 12/27 genotype 1/4). At week 12, 52% of patients were HCV RNA negative and 72% had a >2 log10 decrease in viral load, compared with baseline; 87% and 71% of these patients, respectively, attained an SVR. Therapy was discontinued in 3 patients as a result of adverse events. No patient required ribavirin dose reduction; PEG-IFN-alpha2b dose was reduced in 23% of patients to manage neutropenia. CONCLUSIONS: Combination therapy with PEG-IFN-alpha2b and ribavirin treatment was effective in children with chronic hepatitis C. Virologic status at week 12 identified future responders and nonresponders. PEG-IFN-alpha2b and ribavirin were reasonably well tolerated, with no unexpected or permanent adverse effects. Further studies are needed to identify the optimum treatment regimen for this patient population.

Colèstasi neonatal / Neonatal colestasis

Fonament. La icterícia neonatal és un simptoma freqüentque en alguna ocasió pot posar de manifest malaltieshepàtiques greus. La sospita de l’existència d’hepatopatiaes fonamenta en la presència d’icterícia persistent acàrrec de la bilirrubina directa amb hipocòlia o acòlia i colúria(colèstasi).Objectiu. Determinar els diferents nivells diagnòsticsdins de l’estudi de la colèstasi neonatal així com el tractamenti el pronòstic de las entitats més freqüents.Mètode. Recerca bibliogràfica a partir de bases de dadesinformàtiques.Resultats i conclusions. És important l’estudi de lacolèstasi neonatal doncs existeixen causes amb tractamenteficaç i altres que per la seva gravetat requererixendiagnòstic precoç per a un seguiment més estricte, essentpossible en alguna d’elles tractaments mèdics o quirúrgicsque retrassen la indicació del trasplantament hepàtic

Background. Neonatal jaundice is and frequent symptomthat in some occasions can be the presenting sign ofsevere liver disease. The suspicion of the existence of anunderlying liver disease is based on the presence of persistetjaundice due to elevated conjugated bilirubin with hypocoliaor acolia, and coluria (colestasis).Objectives. To determine the different diagnostic levelsin the study of neonatal colestasis and to review thetreatment and outcome of the most common diseases.Methods. Review of the literature using electronicdatabases.Results and conclusions. It is very important to evaluatein detail all cases of neonatal colestasis. In somecases, a very effective treatment can be implemented,whereas in some severe conditions, an early diagnosis mayallow for a close follow-up and the administration of somemedical and surgical treatments that may delay the needfor a liver transplant