title: Simulect and HHV-6 in pediatric renal transplantation.
abstract: Herpes virus reactivation is of increasing interest as we aim to decrease morbidity and mortality in the pediatric renal transplant population. We previously reported increased reactivation of HHV-6 and Epstein Barr virus (EBV) with anti-thymocyte globulin/ALG induction therapy. HHV-6 reactivation and de novo infection has been monitored in 31 consecutive pediatric renal transplant patients receiving antibody induction with Simulect. Human Herpes virus-6 (HHV-6) was correlated with EBV reactivation and de novo infection rates, allograft function at 1 year, donor source and number, and patient age and gender. One HHV-6 de novo infection was associated with an early grade II rejection that was steroid resistant but ATG/ALG responsive. Sixteen of 31 (54.8%) patients had HHV-6 reactivation during the first year and eight patients had a prior reactivation profile before transplant. Thirteen patients (41.9%) were naïve to EBV infection prior to transplant with evidence of primary infection in 11 of 13 patients between 6 weeks and 1 year posttransplant. EBV reactivation was noted in four patients with past immunity to EBV. IgM Ab to EBV or HHV-6 during the first year posttransplant did not correlate with risk of rejection during the first year or graft function one year posttransplant. The only patient with positive HHV-6 IgM Ab in the first posttransplant month was a de novo infection in a 2-year-old boy who was naïve for HHV-6 at the time of transplant. Simulect appears safe in pediatric renal transplant with low risk of HHV-6 or EBV infection in the first 1 to 2 months posttransplant.
authors.affiliation: Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada. philip.acott@iwk.nshealth.ca
authors.forename: P D
authors.initials: PD
authors.lastname: Acott
authors.forename: J F S
authors.initials: JF
authors.lastname: Crocker
authors.forename: S
authors.initials: S
authors.lastname: Lee
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000914:Antibodies, Viral / Q000097:blood; D000077552:Basiliximab; D002648:Child; D002675:Child, Preschool; D016903:Drug Monitoring; D015654:Herpesvirus 6, Human / Q000302:isolation & purification; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007166:Immunosuppressive Agents; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology / Q000821:virology; D011184:Postoperative Period; D011241:Prednisone / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D019349:Roseolovirus Infections / Q000453:epidemiology*
chemical_list: D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D000914:Antibodies, Viral; D007075:Immunoglobulin M; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; D011241:Prednisone; D008775:Methylprednisolone