title: Subclinical cytomegalovirus and Epstein-Barr virus viremia are associated with adverse outcomes in pediatric renal transplantation.
abstract: Post-transplant clinical disease with cytomegalovirus (CMV) and Epstein-Barr virus (EBV) is a known risk factor for graft dysfunction and lymphoproliferation. We postulate that subclinical, asymptomatic viremia also adversely impacts outcomes, and may warrant re-assessment of current monitoring and antiviral prophylaxis protocols. A single-center study was conducted on 102 pediatric (51 steroid-free and 51 matched steroid-based historical controls). Quantitative viral loads were serially monitored and correlated with outcome measures. Overall, the incidence of CMV and EBV clinical disease was 5% (1% CMV and 4% EBV); however, the incidence of subclinical viremia was 44% (12.7% CMV, 38.2% EBV, 6.9% CMV + EBV). Risk factors for subclinical viremia were EBV naivety (p = 0.07), age less than five yr (p = 0.04), lack of prophylaxis (p = 0.01), and steroid usage (p = 0.0007). Subclinical viremia was associated with lower three-yr graft function (p = 0.03), increased risk of acute rejection (odds ratio 2.07; p = 0.025), hypertension (p = 0.04), and graft loss (p = 0.03). Subclinical asymptomatic CMV and EBV viremia is a risk factor for graft injury and loss. These findings support the need for aggressive, serial viral monitoring to better determine the appropriate length of post-transplant antiviral prophylaxis, and to determine the effect of immunosuppression protocols on the development of viremia.
authors.affiliation: Department of Pediatrics, Stanford University, Palo Alto, CA, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.forename: Abanti
authors.initials: A
authors.lastname: Chaudhuri
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Weintraub
authors.forename: Frank
authors.initials: F
authors.lastname: Hsieh
authors.forename: Sheryl
authors.initials: S
authors.lastname: Shah
authors.forename: Steven
authors.initials: S
authors.lastname: Alexander
authors.forename: Oscar
authors.initials: O
authors.lastname: Salvatierra
authors.forename: Minnie M
authors.initials: MM
authors.lastname: Sarwal
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000517:prevention & control; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology* / Q000517:prevention & control; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D015999:Multivariate Analysis; D012307:Risk Factors; D019562:Viral Load; D014766:Viremia / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control / Q000821:virology*
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir