Britta Höcker1, Sebastian Zencke, Kai Krupka, Alexander Fichtner, Lars Pape, Luca Dello Strologo, Isabella Guzzo, Rezan Topaloglu, Birgitta Kranz, Jens König, Martin Bald, Nicholas J A Webb, Aytül Noyan, Hasan Dursun, Stephen Marks, Fatos Yalcinkaya, Florian Thiel, Heiko Billing, Martin Pohl, Henry Fehrenbach, Thomas Bruckner, Burkhard Tönshoff. 1. 1 Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany. 2 Hanover Medical School, Hanover, Germany. 3 IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy. 4 Faculty of Medicine, Department of Pediatric Nephrology, Hacettepe University, Ankara, Turkey. 5 University Children's Hospital, Department of General Pediatrics, Pediatric Nephrology, Münster, Germany. 6 Olga Children's Hospital, Clinic of Stuttgart, Stuttgart, Germany. 7 Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Center, Manchester, United Kingdom. 8 Baskent University, Adana Teaching and Research Center, Department of Pediatric Nephrology, Adana, Turkey. 9 Great Ormond Street Hospital, Great Ormond Street, London, United Kingdom. 10 Ankara University Faculty of Medicine, Dikimevi, Ankara, Turkey. 11 University Children's Hospital, Hamburg, Germany. 12 University Children's Hospital, Tübingen, Germany. 13 University Children's Hospital, Freiburg, Germany. 14 Children's Hospital, Memmingen, Germany. 15 Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
Abstract
BACKGROUND: Cytomegalovirus (CMV) replication and disease, with its associated morbidity and poor transplant outcome, represents a serious threat to transplant recipients. The pediatric kidney transplant population is at a particularly increased risk of CMV infection. METHODS: We therefore analyzed CMV epidemiology in a large cohort of pediatric renal transplant recipients (n = 242) and assessed the impact of antiviral chemoprophylaxis with valganciclovir (VGCV) or ganciclovir (GCV) on CMV replication and morbidity. RESULTS: While antiviral chemoprophylaxis with VGCV or GCV in patients with a high (D+/R-) or intermediate (D+/R+) CMV risk (n = 82) compared to preemptive therapy (n = 47) had no significant effect on the incidence of CMV syndrome or tissue-invasive disease, chemoprophylaxis was associated with a better preservation of transplant function at 3 years posttransplant (loss of estimated glomerular filtration rate in the chemoprophylaxis cohort, 16.0 ± 3.4 vs. 30.1 ± 4.7 mL/min per 1.73 m(2) in the preemptive therapy cohort, P < 0.05).CMV replication was associated with a more pronounced decline of graft function (difference in estimated glomerular filtration rate of 9.6 mL/min per 1.73 m(2) at 3 years) compared to patients without CMV replication. However, patients undergoing VGCV or GCV chemoprophylaxis had more leukocytopenia. CONCLUSION: Antiviral chemoprophylaxis with VGCV or GCV in recipients with a high or moderate CMV risk is associated with a better preservation of transplant function. Hence, the prevention of CMV replication in this patient population has the potential to improve transplant outcome.
BACKGROUND: Cytomegalovirus (CMV) replication and disease, with its associated morbidity and poor transplant outcome, represents a serious threat to transplant recipients. The pediatric kidney transplant population is at a particularly increased risk of CMV infection. METHODS: We therefore analyzed CMV epidemiology in a large cohort of pediatric renal transplant recipients (n = 242) and assessed the impact of antiviral chemoprophylaxis with valganciclovir (VGCV) or ganciclovir (GCV) on CMV replication and morbidity. RESULTS: While antiviral chemoprophylaxis with VGCV or GCV in patients with a high (D+/R-) or intermediate (D+/R+) CMV risk (n = 82) compared to preemptive therapy (n = 47) had no significant effect on the incidence of CMV syndrome or tissue-invasive disease, chemoprophylaxis was associated with a better preservation of transplant function at 3 years posttransplant (loss of estimated glomerular filtration rate in the chemoprophylaxis cohort, 16.0 ± 3.4 vs. 30.1 ± 4.7 mL/min per 1.73 m(2) in the preemptive therapy cohort, P < 0.05).CMV replication was associated with a more pronounced decline of graft function (difference in estimated glomerular filtration rate of 9.6 mL/min per 1.73 m(2) at 3 years) compared to patients without CMV replication. However, patients undergoing VGCV or GCV chemoprophylaxis had more leukocytopenia. CONCLUSION: Antiviral chemoprophylaxis with VGCV or GCV in recipients with a high or moderate CMV risk is associated with a better preservation of transplant function. Hence, the prevention of CMV replication in this patient population has the potential to improve transplant outcome.
Authors: Britta Höcker; Julia Tabatabai; Lukas Schneble; Jun Oh; Florian Thiel; Lars Pape; Krisztina Rusai; Rezan Topaloglu; Birgitta Kranz; Günter Klaus; Nikoleta Printza; Onder Yavascan; Alexander Fichtner; Kai Krupka; Thomas Bruckner; Rüdiger Waldherr; Michael Pawlita; Paul Schnitzler; Hans H Hirsch; Burkhard Tönshoff Journal: Pediatr Nephrol Date: 2018-07-30 Impact factor: 3.714