Browsing by Author "Fichtner, Alexander"

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    Cytomegalovirus Infection in Pediatric Renal Transplantation and the Impact of Chemoprophylaxis With (Val-)Ganciclovir
    (2016) 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; https://orcid.org/0000-0002-8817-494X; 26736017; AAD-5713-2021; AAB-7105-2020
    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.