Cytomegalovirus infection in pediatric renal transplantation and the impact of chemoprophylaxis with (val-)ganciclovir

• Verfasst von: Höcker, Britta [VerfasserIn]
• Verfasst von: Zencke, Sebastian [VerfasserIn]
• Verfasst von: Krupka, Kai [VerfasserIn]
• Verfasst von: Fichtner, Alexander [VerfasserIn]
• Verfasst von: Bruckner, Thomas [VerfasserIn]
• Verfasst von: Tönshoff, Burkhard [VerfasserIn]
• Titel: Cytomegalovirus infection in pediatric renal transplantation and the impact of chemoprophylaxis with (val-)ganciclovir
• Verf.angabe: Britta Höcker, MD, Sebastian Zencke, Kai Krupka, Alexander Fichtner, MD, Lars Pape, MD, Luca Dello Strologo, Isabella Guzzo, Rezan Topaloglu, Birgitta Kranz, Jens König, Martin Bald, Nicholas J. A. Webb, Aytül Noyan, Hasan Dursun, Stephen Marks, Fatos Yalcinkaya, Florian Thiel, Heiko Billing, Martin Pohl, Henry Fehrenbach, Thomas Bruckner, PhD, and Burkhard Tönshoff, MD, PhD
• E-Jahr: 2016
• Jahr: April 2016
• Umfang: 9 S.
• Fussnoten: Gesehen am 15.11.2019
• Titel Quelle: Enthalten in: Transplantation
• Ort Quelle: Hagerstown, Md. : Lippincott Williams & Wilkins, 1963
• Jahr Quelle: 2016
• Band/Heft Quelle: 100(2016), 4, Seite 862-870
• ISSN Quelle: 1534-6080
• DOI: doi:10.1097/TP.0000000000000888
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1681991551

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 m2 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 m2 at 3 years) compared to patients without CMV replication. However, patients undergoing VGCV or GCV chemoprophylaxis had more leukocytopenia. - Conclusion 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.