Cytomegalovirus Infection in Infants with Biliary Atresia in China: a Multi-center Investigation Study

Yilin Zhao #^1,2Xiaodan Xu #^1,2Yu Meng^1,2Chonggao Zhou³Baijun Zheng⁴Xianwei Zhang⁵Bin Wang⁶Xufei Duan⁷Yuanmei Liu⁸Jiexiong Feng⁹Jie Zhu¹⁰Zhibo Zhang¹¹Yajun Chen¹²Zhibao Lv¹³Yuanjun Hu¹⁴Hongxia Ren¹⁵Liuming Huang¹²Yingchao Li¹⁶Liang Ge¹Haochuan Zhang¹⁷Xiang Liu¹⁸Li Wanfu¹⁹Qingbo Cui²⁰Jianghua Zhan^1*

• ¹Tianjin Children's Hospital, Tianjin, China
• ²Tianjin Medical University, Tianjin, Tianjin Municipality, China
• ³Hunan Children's Hospital, Changsha, Hunan Province, China
• ⁴The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
• ⁵Henan Children’s hospital, Zhengzhou, China
• ⁶Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
• ⁷Precision Medical Center, Wuhan Children's Hospital, Wuhan, Hebei Province, China
• ⁸Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China
• ⁹Tongji Hospital of Tongji Medical College, Wuhan, China
• ¹⁰Children's Hospital of Soochow University, Suzhou, Jiangsu Province, China
• ¹¹Sheng Jing Hospital Affiliated, China Medical University, Shenyang, Liaoning Province, China
• ¹²Beijing Children’s Hospital, Capital Medical University, Beijing, Beijing Municipality, China
• ¹³Shanghai Children's Hospital, Shanghai, Shanghai Municipality, China
• ¹⁴Jinan Children's Hospital, Jinan, Shandong Province, China
• ¹⁵Shanxi Provincial Children's Hospital, Taiyuan, Shanxi Province, China
• ¹⁶Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
• ¹⁷The 2nd School of Medicine. WMU/The 2nd Affiliated Hospital and Yuying Children’s Hospital of WMU, Wenzhou, China
• ¹⁸Anhui Provincial Children’s Hospital, Hefei, Anhui Province, China
• ¹⁹First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur Region, China
• ²⁰The Sixth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China

Background and Objectives: Biliary atresia (BA) with concurrent cytomegalovirus (CMV) is a distinct subtype that is linked to a poorer prognosis. Currently, there are no standardized criteria for the diagnosis or antiviral treatment (AVT) of this condition. It has a high prevalence in China. The aim was to investigate the infection, diagnosis and treatment of CMV infection in infants with BA through a multicenter questionnaire survey conducted in China. Methods: A multicenter investigation was performed through online questionnaire survey. It investigated the diagnosis and treatment of infants with CMV-infected BA in tertiary-level pediatric centers from January 1st, 2018, to January 1st, 2020. The centers were categorized into low and high-volume groups based on number of infants with BA (≤50 or >50) and were also grouped geographically into south and north groups. Afterward, 100 cases were randomly selected from these infants for a retrospective analysis.Results: A total of 22 questionnaires were collected, and 20 were included in the analysis. The questionnaire survey encompassed 1,276 infants with type III BA. 31.3% of the infants of BA had CMV detected. According to the survey results, a large proportion of centers preferred using CMV-DNA (75.0%) and CMV-IgM (95.0%) as their preferred methods for CMV detection. In the high-volume group, more centers opted for CMV-DNA detection (100.0% vs. 66.7%) and administered AVT (87.5%). In the retrospective analysis of 100 infants with BA, 39 were found to be CMV-positive and among these, 74.4% received AVT.Conclusion: Among the 1,276 infants with BA in this cohort, 31.3% (399 cases) had concomitant CMV infection, representing a decrease compared to previous data. CMV-IgM played a crucial role in the detection of the infection. The retrospective analysis indicated that AVT had a beneficial impact on the prognosis of infants with BA who were infected with CMV.