title: Cytomegalovirus transmission in pediatric renal transplant recipients during the window period.
abstract: We report two CMV naïve children who received deceased donor renal transplants from a CMV IgG-negative single donor. CMV IgG in both recipients and the donor were negative immediately prior to transplant. Both recipients had early recurrences of their original disease in their transplants, requiring multiple sessions of plasmapheresis. All blood products used were leukoreduced or CMV seronegative. A few days post-transplant, both recipients developed significant positive CMV viremia. Both required initiation of oral valganciclovir. Case 1 responded to oral valganciclovir only while the case 2 had a delayed response to it and hence required intravenous ganciclovir with good response. When checked retrospectively, CMV IgM in the donor was positive along with positive CMV DNA PCR from the white cells. Here we describe a very unusual scenario of CMV transmission in two pediatric renal transplant recipients from a single donor during the CMV window period.
authors.affiliation: Division of Nephrology, Department of Pediatrics, Shands Children's Hospital, University of Florida, Gainesville, FL, USA.
authors.forename: Sanhita
authors.initials: S
authors.lastname: Gangopadhyay
authors.affiliation: Shands Hospital Virology Laboratory, University of Florida Health, Gainesville, FL, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Rampersaud
authors.affiliation: Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: J Peter R
authors.initials: JP
authors.lastname: Pelletier
authors.affiliation: Division of Nephrology, Department of Pediatrics, Shands Children's Hospital, University of Florida, Gainesville, FL, USA.
authors.forename: Lettie
authors.initials: L
authors.lastname: Herman
authors.affiliation: Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Goldstein
authors.affiliation: Division of Nephrology, Department of Pediatrics, Shands Children's Hospital, University of Florida, Gainesville, FL, USA.
authors.forename: Kiran
authors.initials: K
authors.lastname: Upadhyay
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000635:transmission*; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D011184:Postoperative Period; D051437:Renal Insufficiency / Q000150:complications / Q000601:surgery* / Q000821:virology; D012189:Retrospective Studies; D012307:Risk Factors; D066027:Transplant Recipients; D016896:Treatment Outcome; D000077562:Valganciclovir
chemical_list: D000914:Antibodies, Viral; D000998:Antiviral Agents; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D000077562:Valganciclovir; D015774:Ganciclovir
keywords: cytomegalovirus; pediatric; renal transplant; window