BACKGROUND: Cytomegalovirus (CMV) is the most common opportunistic infection after solid-organ transplant. Valganciclovir prophylaxis significantly reduces disease, but limited data are available on its use in children. Recently, an increase in delayed-onset CMV disease has been noted with some arguing that longer prophylaxis may decrease late-onset disease. METHODS: Single-center, retrospective analysis of pediatric renal transplant patients receiving 24 weeks valganciclovir prophylaxis (15 mg/kg/day, maximum 900 mg/day) from January 2004 to December 2008, aiming to measure the incidence of CMV disease and toxicity of valganciclovir. RESULTS: We enrolled 111 patients, 60% males, 46% African Americans, and median age at transplant 14.5 years (range 1.4-20.4 years). Sixty-nine percent of donors and 44% of recipients were seropositive pretransplant. Median duration of valganciclovir use was 5.9 months (range 0.5-24 months). CMV viremia and disease occurred in 27% and 4.5%, respectively. All patients with disease presented after prophylaxis ended and all were D+/R-. Thymoglobulin use (P = 0.04) and positive donor CMV status (P = 0.02) were associated with a higher risk of CMV viremia. Twenty-four percent had hematologic toxicity directly associated with valganciclovir. CONCLUSIONS: Valganciclovir use in children was effective as prophylaxis against CMV disease; no children at our institution developed disease while on therapy. Our regimen of 24 weeks of prophylaxis was associated with a lower rate of late-onset disease than previous reports with 12-week regimens. Further controlled studies should be considered to compare longer versus shorter periods of prophylaxis and dose reductions and their impact on prevention of late-onset disease, resistance, cost, and toxicity.
BACKGROUND:Cytomegalovirus (CMV) is the most common opportunistic infection after solid-organ transplant. Valganciclovir prophylaxis significantly reduces disease, but limited data are available on its use in children. Recently, an increase in delayed-onset CMV disease has been noted with some arguing that longer prophylaxis may decrease late-onset disease. METHODS: Single-center, retrospective analysis of pediatric renal transplant patients receiving 24 weeks valganciclovir prophylaxis (15 mg/kg/day, maximum 900 mg/day) from January 2004 to December 2008, aiming to measure the incidence of CMV disease and toxicity of valganciclovir. RESULTS: We enrolled 111 patients, 60% males, 46% African Americans, and median age at transplant 14.5 years (range 1.4-20.4 years). Sixty-nine percent of donors and 44% of recipients were seropositive pretransplant. Median duration of valganciclovir use was 5.9 months (range 0.5-24 months). CMV viremia and disease occurred in 27% and 4.5%, respectively. All patients with disease presented after prophylaxis ended and all were D+/R-. Thymoglobulin use (P = 0.04) and positive donor CMV status (P = 0.02) were associated with a higher risk of CMV viremia. Twenty-four percent had hematologic toxicity directly associated with valganciclovir. CONCLUSIONS:Valganciclovir use in children was effective as prophylaxis against CMV disease; no children at our institution developed disease while on therapy. Our regimen of 24 weeks of prophylaxis was associated with a lower rate of late-onset disease than previous reports with 12-week regimens. Further controlled studies should be considered to compare longer versus shorter periods of prophylaxis and dose reductions and their impact on prevention of late-onset disease, resistance, cost, and toxicity.
Authors: J A Khoury; G A Storch; D L Bohl; R M Schuessler; S M Torrence; M Lockwood; M Gaudreault-Keener; M J Koch; B W Miller; K L Hardinger; M A Schnitzler; D C Brennan Journal: Am J Transplant Date: 2006-06-19 Impact factor: 8.086
Authors: Ajit P Limaye; Ramasamy Bakthavatsalam; Hyung W Kim; Sara E Randolph; Jeffrey B Halldorson; Patrick J Healey; Christian S Kuhr; Adam E Levy; James D Perkins; Jorge D Reyes; Michael Boeckh Journal: Transplantation Date: 2006-06-27 Impact factor: 4.939
Authors: Alden M Doyle; Karen M Warburton; Simin Goral; Emily Blumberg; Robert A Grossman; Roy D Bloom Journal: Transplantation Date: 2006-04-27 Impact factor: 4.939
Authors: Francis L Weng; Anup M Patel; Rimda Wanchoo; Yasmin Brahmbhatt; Kezia Ribeiro; Marc E Uknis; Shamkant Mulgaonkar; A Scott Mathis Journal: Transplantation Date: 2007-02-15 Impact factor: 4.939
Authors: Steven Gabardi; Colm C Magee; Steven A Baroletti; John A Powelson; Jennifer L Cina; Anil K Chandraker Journal: Pharmacotherapy Date: 2004-10 Impact factor: 4.705