title: (Val-)Ganciclovir prophylaxis reduces Epstein-Barr virus primary infection in pediatric renal transplantation.
abstract: Epstein-Barr virus (EBV) primary infection constitutes a serious risk for pediatric transplant recipients, particularly as regards the development of EBV-related post-transplant lymphoproliferative disease (PTLD). Currently, there is no established prophylactic regimen. We investigated the association between chemoprophylaxis with valganciclovir (VGCV) or ganciclovir (GCV) and the incidence of EBV viremia in EBV-naïve pediatric renal transplant recipients (R-) who had received a graft from an EBV-positive donor (D+) and are therefore at high risk of EBV primary infection. In a prospective, multicenter trial (n = 114), we compared a cohort on chemoprophylaxis (n = 20) with a similar control cohort without chemoprophylaxis (n = 8). Over the 1-year study period, antiviral prophylaxis with VGCV/GCV was associated with a significantly decreased incidence of EBV primary infection: 9/20 patients (45%) in the prophylaxis group experienced an EBV primary infection compared to 8/8 controls (100%) (P < 0.0001). Chemoprophylaxis was associated with a significantly lower EBV viral load (P < 0.001). Type or intensity of immunosuppressive therapy did not influence the occurrence of EBV primary infection or the level/persistence of EBV viral load. Chemoprophylaxis with VGCV/GCV is associated with a reduced incidence of EBV viremia in high-risk pediatric kidney allograft recipients in the first year post-transplant. (ClinicalTrials.gov number: NCT00963248).
authors.affiliation: University Children's Hospital, Heidelberg, Germany.
authors.forename: Britta
authors.initials: B
authors.lastname: Höcker
authors.forename: Stephan
authors.initials: S
authors.lastname: Böhm
authors.forename: Helmut
authors.initials: H
authors.lastname: Fickenscher
authors.forename: Uta
authors.initials: U
authors.lastname: Küsters
authors.forename: Paul
authors.initials: P
authors.lastname: Schnitzler
authors.forename: Martin
authors.initials: M
authors.lastname: Pohl
authors.forename: Ulrike
authors.initials: U
authors.lastname: John
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Kemper
authors.forename: Henry
authors.initials: H
authors.lastname: Fehrenbach
authors.forename: Marianne
authors.initials: M
authors.lastname: Wigger
authors.forename: Martin
authors.initials: M
authors.lastname: Holder
authors.forename: Monika
authors.initials: M
authors.lastname: Schröder
authors.forename: Reinhard
authors.initials: R
authors.lastname: Feneberg
authors.forename: Sabine
authors.initials: S
authors.lastname: Köpf-Shakib
authors.forename: Burkhard
authors.initials: B
authors.lastname: Tönshoff
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D018890:Chemoprevention / Q000379:methods; D002648:Child; D015331:Cohort Studies; D020031:Epstein-Barr Virus Infections / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D004854:Herpesvirus 4, Human / Q000378:metabolism*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods*; D008232:Lymphoproliferative Disorders / Q000209:etiology; D008297:Male; D010372:Pediatrics / Q000379:methods; D011446:Prospective Studies; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D000077562:Valganciclovir; D015774:Ganciclovir