Intravenous immunoglobulin prophylaxis of cytomegalovirus infection in pediatric renal transplant recipients.
Cytomegalovirus (CMV), the most significant infectious cause of morbidity following renal transplantation, may be a greater problem for children than for adults due to their relative lack of experience with this virus. Therefore, we prospectively gave Gammagard as prophylaxis to CMV-negative children who received CMV-positive allografts and compared the results to our experience with similar high-risk recipients transplanted prior to our use of intravenous immunoglobulin G (IvIgG). Symptomatic CMV disease developed in 17% of the IvIgG recipients as compared with 71% of the untreated patients (p = 0.01). The CMV infections that did occur in IvIgG recipients developed significantly later than in untreated children (median time of onset after transplantation 2.60 vs. 1.35 months; p < 0.05) and generally were less severe, although 1 IvIgG recipient died despite prophylaxis. IvIgG administration did not affect the frequency of rejection or graft or patient survival. We conclude that IvIgG administration to high-risk pediatric renal transplant recipients may protect against posttransplantation CMV disease and may lessen the severity of infections that do develop in patients who receive it.
Flynn
J T
JT
Department of Pediatrics, St. Christopher's Hospital for Children, Temple University of School of Medicine, Philadelphia, Pa., USA.
Kaiser
B A
BA
Long
S S
SS
Schulman
S L
SL
Deforest
A
A
Polinsky
M S
MS
Baluarte
H J
HJ
D002648:Child; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation; D008297:Male; D009017:Morbidity; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors
D016756:Immunoglobulins, Intravenous