Grant Paulsen1,2, Pia Cumagun3, Emily Mixon4, Karen Fowler4,5, Daniel Feig6, Masako Shimamura7,8. 1. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio. 2. Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 3. University of Alabama School of Medicine, Birmingham, Alabama. 4. Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama. 5. Division of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama. 6. Division of Pediatric Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama. 7. Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio. 8. Division of Pediatric Infectious Diseases, Department of Pediatrics, The Ohio State University, Columbus, Ohio.
Abstract
BACKGROUND: CMV is associated with adverse effects in renal transplant recipients. The objective of this study was to characterize the incidence and timing of CMV and EBV infections in relation to valGCV prophylaxis in a pediatric renal transplant cohort. METHODS: Retrospective cohort of pediatric renal transplant patients given universal valGCV prophylaxis and universal viral surveillance was evaluated. Demographics, prophylaxis, acute rejection, and CMV and EBV infections were abstracted. RESULTS: A total of 92 pediatric renal allograft recipients, 2008-2013, were included. One or more viral infections developed in 77/92 (83.7%) of the patients. EBV was the most common in 62/92 (67%) patients, irrespective of valGCV (82% of episodes occurring on valGCV). CMV DNAemia occurred in 30/92 (33%) patients, 14 episodes (47%) occurring on valGCV. Incidence of breakthrough CMV on prophylaxis was 15% and was associated with persistent DNAemia (OR 7.8, CI:1.6-32.9, P < 0.02). CMV tissue-invasive disease was not seen. CMV syndrome occurred in 10% of the cohort, only in CMV D+ patients, and only one symptomatic breakthrough infection required treatment. Out of 92, 21 (23%) had simultaneous co-infections with 2-3 viruses. CONCLUSIONS: Viral infections in pediatric renal transplant recipients receiving universal valGCV prophylaxis were common. EBV infections were not reduced by valGCV prophylaxis, and nearly half of CMV infections occurred on valGCV. Symptomatic CMV infection while on prophylaxis was rare. valGCV prophylaxis may prevent symptomatic CMV infection but not EBV infection, and frequent CMV surveillance in pediatric renal transplant recipients on prophylaxis may not be necessary.
BACKGROUND: CMV is associated with adverse effects in renal transplant recipients. The objective of this study was to characterize the incidence and timing of CMV and EBV infections in relation to valGCV prophylaxis in a pediatric renal transplant cohort. METHODS: Retrospective cohort of pediatric renal transplant patients given universal valGCV prophylaxis and universal viral surveillance was evaluated. Demographics, prophylaxis, acute rejection, and CMV and EBV infections were abstracted. RESULTS: A total of 92 pediatric renal allograft recipients, 2008-2013, were included. One or more viral infections developed in 77/92 (83.7%) of the patients. EBV was the most common in 62/92 (67%) patients, irrespective of valGCV (82% of episodes occurring on valGCV). CMV DNAemia occurred in 30/92 (33%) patients, 14 episodes (47%) occurring on valGCV. Incidence of breakthrough CMV on prophylaxis was 15% and was associated with persistent DNAemia (OR 7.8, CI:1.6-32.9, P < 0.02). CMV tissue-invasive disease was not seen. CMV syndrome occurred in 10% of the cohort, only in CMV D+ patients, and only one symptomatic breakthrough infection required treatment. Out of 92, 21 (23%) had simultaneous co-infections with 2-3 viruses. CONCLUSIONS:Viral infections in pediatric renal transplant recipients receiving universal valGCV prophylaxis were common. EBV infections were not reduced by valGCV prophylaxis, and nearly half of CMV infections occurred on valGCV. Symptomatic CMV infection while on prophylaxis was rare. valGCV prophylaxis may prevent symptomatic CMV infection but not EBVinfection, and frequent CMV surveillance in pediatric renal transplant recipients on prophylaxis may not be necessary.
Authors: Britta Höcker; 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 Journal: Transplantation Date: 2016-04 Impact factor: 4.939
Authors: H J Zar; D P Moore; S Andronikou; A C Argent; T Avenant; C Cohen; R J Green; G Itzikowitz; P Jeena; R Masekela; M P Nicol; A Pillay; G Reubenson; S A Madhi Journal: Afr J Thorac Crit Care Med Date: 2020-10-13