title: The efficacy of valganciclovir for prevention of infections with cytomegalovirus and Epstein-Barr virus after kidney transplant in children.
abstract: This study evaluated the efficacy of prophylactic ValGCV in preventing CMV and EBV infections in a single-center pediatric kidney transplant population (2008-2014). Therapy duration was determined according to donor/recipient serostatus. EBV monitoring was performed using monthly plasma PCR for 18 months post-transplant and for CMV, monthly for 6 months after prophylaxis cessation. Data were collected on 35 children, median age 10.6 years. There were 15 (42.9%) and 11 (31.4%) recipients seronegative for CMV or EBV, respectively, who received a kidney from a seropositive donor. Prophylaxis was ceased by 6 months in 24 (69%), between seven and 13 months in 10 (29%) children. Fourteen (40%) and eight (23%) children experienced CMV and EBV DNAemia, respectively. Ten of the 14 (71%) episodes of CMV DNAemia occurred in the first 6 months following cessation of prophylaxis. Shorter prophylaxis was associated with increased CMV DNAemia (P = 0.044). There was an inverse correlation between adjusted ValGCV dose and EBV incidence/timing. Neutropenia was more common if ValGCV dosage was ≥10% of the dose predicted (by BSA and creatinine clearance). ValGCV prevents CMV and may modify EBV infection risk. Frequent dosing adjustment for BSA and creatinine clearance is required to optimize safety and efficacy.
authors.affiliation: School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.
authors.forename: Bernadette M
authors.initials: BM
authors.lastname: Cameron
authors.affiliation: School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.|Department of Nephrology, Sydney Children's Hospital, Sydney, Australia.
authors.forename: Sean E
authors.initials: SE
authors.lastname: Kennedy
authors.affiliation: Virology Division, Prince of Wales Hospital, Sydney, Australia.|SEALS Microbiology, Prince of Wales Hospital, Sydney, Australia.|School of Medical Sciences, University of New South Wales, Sydney, Australia.
authors.forename: William D
authors.initials: WD
authors.lastname: Rawlinson
authors.affiliation: School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.|Department of Nephrology, Sydney Children's Hospital, Sydney, Australia.
authors.forename: Fiona E
authors.initials: FE
authors.lastname: Mackie
mesh_terms: D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000517:prevention & control*; D020031:Epstein-Barr Virus Infections / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D004854:Herpesvirus 4, Human; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D009503:Neutropenia / Q000150:complications; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000032:analysis; D012189:Retrospective Studies; D014019:Tissue Donors; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D012367:RNA, Viral; D000077562:Valganciclovir; D015774:Ganciclovir
keywords: CMV; Epstein-Barr virus; PCR; child; kidney transplantation; viral infection