title: Cytomegalovirus Infection in Pediatric Renal Transplantation and the Impact of Chemoprophylaxis With (Val-)Ganciclovir.
abstract: BACKGROUND
  Cytomegalovirus (CMV) replication and disease, with its associated morbidity and poor transplant outcome, represents a serious threat to transplant recipients. The pediatric kidney transplant population is at a particularly increased risk of CMV infection.
  
  
  METHODS
  We therefore analyzed CMV epidemiology in a large cohort of pediatric renal transplant recipients (n = 242) and assessed the impact of antiviral chemoprophylaxis with valganciclovir (VGCV) or ganciclovir (GCV) on CMV replication and morbidity.
  
  
  RESULTS
  While antiviral chemoprophylaxis with VGCV or GCV in patients with a high (D+/R-) or intermediate (D+/R+) CMV risk (n = 82) compared to preemptive therapy (n = 47) had no significant effect on the incidence of CMV syndrome or tissue-invasive disease, chemoprophylaxis was associated with a better preservation of transplant function at 3 years posttransplant (loss of estimated glomerular filtration rate in the chemoprophylaxis cohort, 16.0 ± 3.4 vs. 30.1 ± 4.7 mL/min per 1.73 m(2) in the preemptive therapy cohort, P < 0.05).CMV replication was associated with a more pronounced decline of graft function (difference in estimated glomerular filtration rate of 9.6 mL/min per 1.73 m(2) at 3 years) compared to patients without CMV replication. However, patients undergoing VGCV or GCV chemoprophylaxis had more leukocytopenia.
  
  
  CONCLUSIONS
  Antiviral chemoprophylaxis with VGCV or GCV in recipients with a high or moderate CMV risk is associated with a better preservation of transplant function. Hence, the prevention of CMV replication in this patient population has the potential to improve transplant outcome.
authors.affiliation: 1 Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany. 2 Hanover Medical School, Hanover, Germany. 3 IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy. 4 Faculty of Medicine, Department of Pediatric Nephrology, Hacettepe University, Ankara, Turkey. 5 University Children's Hospital, Department of General Pediatrics, Pediatric Nephrology, Münster, Germany. 6 Olga Children's Hospital, Clinic of Stuttgart, Stuttgart, Germany. 7 Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Center, Manchester, United Kingdom. 8 Baskent University, Adana Teaching and Research Center, Department of Pediatric Nephrology, Adana, Turkey. 9 Great Ormond Street Hospital, Great Ormond Street, London, United Kingdom. 10 Ankara University Faculty of Medicine, Dikimevi, Ankara, Turkey. 11 University Children's Hospital, Hamburg, Germany. 12 University Children's Hospital, Tübingen, Germany. 13 University Children's Hospital, Freiburg, Germany. 14 Children's Hospital, Memmingen, Germany. 15 Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
authors.forename: Britta
authors.initials: B
authors.lastname: Höcker
authors.forename: Sebastian
authors.initials: S
authors.lastname: Zencke
authors.forename: Kai
authors.initials: K
authors.lastname: Krupka
authors.forename: Alexander
authors.initials: A
authors.lastname: Fichtner
authors.forename: Lars
authors.initials: L
authors.lastname: Pape
authors.forename: Luca
authors.initials: L
authors.lastname: Dello Strologo
authors.forename: Isabella
authors.initials: I
authors.lastname: Guzzo
authors.forename: Rezan
authors.initials: R
authors.lastname: Topaloglu
authors.forename: Birgitta
authors.initials: B
authors.lastname: Kranz
authors.forename: Jens
authors.initials: J
authors.lastname: König
authors.forename: Martin
authors.initials: M
authors.lastname: Bald
authors.forename: Nicholas J A
authors.initials: NJ
authors.lastname: Webb
authors.forename: Aytül
authors.initials: A
authors.lastname: Noyan
authors.forename: Hasan
authors.initials: H
authors.lastname: Dursun
authors.forename: Stephen
authors.initials: S
authors.lastname: Marks
authors.forename: Fatos
authors.initials: F
authors.lastname: Yalcinkaya
authors.forename: Florian
authors.initials: F
authors.lastname: Thiel
authors.forename: Heiko
authors.initials: H
authors.lastname: Billing
authors.forename: Martin
authors.initials: M
authors.lastname: Pohl
authors.forename: Henry
authors.initials: H
authors.lastname: Fehrenbach
authors.forename: Thomas
authors.initials: T
authors.lastname: Bruckner
authors.forename: Burkhard
authors.initials: B
authors.lastname: Tönshoff
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000187:drug effects* / Q000472:pathogenicity; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D004334:Drug Administration Schedule; D005060:Europe / Q000453:epidemiology; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D009894:Opportunistic Infections / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D000077562:Valganciclovir; D015774:Ganciclovir