title: Cytomegalovirus prophylaxis in pediatric kidney transplantation: the Dutch experience.
abstract: Many children receiving a kidney transplant are seronegative for CMV and therefore, highly susceptible to a primary CMV infection. This study aims at evaluating incidence, time of occurrence, and severity of CMV infection in the first year post-transplantation in relation to different types of CMV prophylaxis. Transplantations in three centers in the Netherlands between 1999 and 2010 were included. Retrospective, observational, multicenter study. Clinical data and PCR measurements of CMV were collected. Prophylaxis in high-risk patients (CMV serostatus D+R-) consisted of (val)ganciclovir during three months, or acyclovir plus CMV immunoglobulin at a former stage. Intermediate-risk patients (R+) received (val)acyclovir, or acyclovir plus CMV immunoglobulin at a former stage. Low-risk patients (D-R-) did not receive prophylaxis. Infection was defined as CMV PCR above 50 geq/mL plasma or whole blood, a clinically relevant infection above 1000 geq/mL. One hundred and fifty-nine transplantations were included. CMV infection was documented for 41% of high-risk, 24% of intermediate-risk, and 13% of low-risk patients, in the latter two groups typically during the first three months. The infection rate was highest in the high-risk group after cessation of valganciclovir prophylaxis. Valganciclovir provided better protection than did acyclovir + CMV immunoglobulin. Adding an IL2-receptor blocker to the immunosuppressive regimen did not affect the infection rate. Acute graft rejection was not related with CMV infection. Valganciclovir prophylaxis effectively prevents CMV infection in high-risk pediatric kidney recipients, but only during prophylaxis. Valacyclovir prophylaxis in intermediate-risk patients is less effective.
authors.affiliation: Department of Pediatric Nephrology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Hidde
authors.initials: H
authors.lastname: Jongsma
authors.forename: Antonia H
authors.initials: AH
authors.lastname: Bouts
authors.forename: Elisabeth A M
authors.initials: EA
authors.lastname: Cornelissen
authors.forename: Matthias F C
authors.initials: MF
authors.lastname: Beersma
authors.forename: Karlien
authors.initials: K
authors.lastname: Cransberg
mesh_terms: D000212:Acyclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000517:prevention & control*; D018572:Disease-Free Survival; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007223:Infant; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods*; D009426:Netherlands; D016133:Polymerase Chain Reaction; D015375:Receptors, Interleukin-2 / Q000037:antagonists & inhibitors; D051437:Renal Insufficiency / Q000150:complications* / Q000821:virology; D012189:Retrospective Studies; D012306:Risk; D000077483:Valacyclovir; D000077562:Valganciclovir; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins; D007166:Immunosuppressive Agents; D015375:Receptors, Interleukin-2; D000077562:Valganciclovir; D014633:Valine; D000077483:Valacyclovir; D015774:Ganciclovir; D000212:Acyclovir
keywords: cytomegalovirus; prophylaxis; valacyclovir; valganciclovir