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Background Methods Results Conclusions Cytomegalovirus (CMV) contributes to morbidity and mortality in allogeneic hematopoietic cell transplantation (allo‐HCT) recipients. Pre‐emptive antiviral therapy (PET) reduces the incidence of CMV end‐organ disease (EOD), though relevant viral thresholds to initiate PET remain undefined. We evaluated the impact of viral loads (VLs) at PET initiation on virologic and clinical outcomes following pediatric allo‐HCT.Single‐center retrospective cohort analysis of children who underwent their first allo‐HCT from January 2014 to December 2020. Weekly quantitative plasma CMV polymerase chain reaction was performed until Day +100 and PET was initiated once VL exceeded a pre‐defined threshold per institutional guidelines. Patients were followed for 1‐year post‐HCT to evaluate virologic and clinical outcomes including end‐organ disease (EOD), overall survival (OS), and non‐relapse mortality (NRM).Among 146 allo‐HCT recipients, CMV DNAemia occurred in 40 patients (27%) at a median of 15 days post‐HCT (interquartile range 6–28.5). Ten percent (n = 4) had spontaneous resolution of DNAemia, while 90% (n = 36) required PET. PET initiated when CMV VL was ≥ 1000 IU/mL (n = 21) vs when VL < 1000 IU/mL (n = 15) resulted in higher peak CMV VL (12,670 vs. 1284 IU/mL, p = 0.0001) and longer time to CMV DNAemia resolution (36 vs. 24 days, p = 0.035). There were no differences in EOD, OS, or NRM at 12 months post‐HCT based on VL at PET initiation.Initiating PET when CMV VL was ≥1000 IU/mL resulted in significantly higher peak VL and prolonged DNAemia, with no differences in EOD, OS, or NRM at 12 months post pediatric HCT. [ABSTRACT FROM AUTHOR]

Background: The opioid crisis has led to an increase in hepatitis C virus‐positive donors in the past decade. Whereas historically hepatitis C seropositive organs were routinely discarded, the advent of direct‐acting antiviral agents has notably expanded the utilization of organs from donors with hepatitis C. There has been growing experience with liver transplantation (LT) from hepatitis C seropositive donors to hepatitis C seropositive recipients. However, data remain limited on LT from hepatitis C seropositive or hepatitis C ribonucleic acid positive donors to hepatitis C seronegative recipients. Methods: We performed a retrospective study of 26 hepatitis C seronegative recipients who received hepatitis C seropositive donor livers followed by preemptive antiviral therapy with direct‐acting antiviral treatment at the Johns Hopkins Hospital Comprehensive Transplant Center from January 1, 2017, to August 31, 2019. Results: Twenty‐five of the 26 recipients are alive with proper graft function; 20 of them received livers from hepatitis C nucleic acid testing positive donors. All 12 recipients who completed their direct‐acting antiviral courses and have reached sufficient follow‐up for sustained virologic response have achieved sustained virologic response. Nine of our recipients have either completed direct‐acting antiviral treatment without sufficient follow‐up time for sustained virologic response or are undergoing direct‐acting antiviral treatment. One patient is awaiting antiviral treatment initiation pending insurance approval. Of note, 11 of 12 patients with sustained virologic response received a hepatitis C nucleic acid testing positive donor liver. Conclusion: Hepatitis C seronegative patients who receive a hepatitis C seropositive or hepatitis C nucleic acid testing positive liver allograft can enjoy good short‐term outcomes with hepatitis C cure following direct‐acting antiviral treatment. [ABSTRACT FROM AUTHOR]