Cytomegalovirus Infection in Pediatric Renal Transplantation and the Impact of Chemoprophylaxis With (Val-)Ganciclovir
Tarih
2016Yazar
Hoecker, Britta
Zencke, Sebastian
Krupka, Kai
Fichtner, Alexander
Pape, Lars
Dello Strologo, Luca
Guzzo, Isabella
Topaloglu, Rezan
Kranz, Birgitta
Koenig, Jens
Bald, Martin
Webb, Nicholas J. A.
Noyan, Aytul
Dursun, Hasan
Marks, Stephen
Yalcinkaya, Fatos
Thiel, Florian
Billing, Heiko
Pohl, Martin
Fehrenbach, Henry
Bruckner, Thomas
Toeshoff, Burkhard
Üst veri
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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 amore 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.