Cytomegalovirus infection in pediatric renal transplantation and the impact of chemoprophylaxis with (val-)ganciclovir

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 FehrenbachThomas Bruckner, Burkhard Tönshoff

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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 andmorbidity. 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 ofCMV 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 m2 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 m2 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.

Original languageEnglish
Pages (from-to)862-870
Number of pages9
JournalTransplantation
Volume100
Issue number4
DOIs
Publication statusPublished - 2016

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ASJC Scopus subject areas

  • Transplantation

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Höcker, B., Zencke, S., Krupka, K., Fichtner, A., Pape, L., Strologo, L. D., Guzzo, I., Topaloglu, R., Kranz, B., König, J., Bald, M., Webb, N. J. A., Noyan, A., Dursun, H., Marks, S., Yalcinkaya, F., Thiel, F., Billing, H., Pohl, M., ... Tönshoff, B. (2016). Cytomegalovirus infection in pediatric renal transplantation and the impact of chemoprophylaxis with (val-)ganciclovir. Transplantation, 100(4), 862-870. https://doi.org/10.1097/TP.0000000000000888