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

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 a...

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Bibliographische Detailangaben
Hauptverfasser: Höcker, Britta (VerfasserIn) , Zencke, Sebastian (VerfasserIn) , Krupka, Kai (VerfasserIn) , Fichtner, Alexander (VerfasserIn) , Bruckner, Thomas (VerfasserIn) , Tönshoff, Burkhard (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: April 2016
In: Transplantation
Year: 2016, Jahrgang: 100, Heft: 4, Pages: 862-870
ISSN:1534-6080
DOI:10.1097/TP.0000000000000888
Online-Zugang:Verlag, Volltext: https://doi.org/10.1097/TP.0000000000000888
Verlag, Volltext: https://journals.lww.com/transplantjournal/fulltext/2016/04000/Cytomegalovirus_Infection_in_Pediatric_Renal.28.aspx
Volltext
Verfasserangaben: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
Beschreibung
Zusammenfassung: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.
Beschreibung:Gesehen am 15.11.2019
Beschreibung:Online Resource
ISSN:1534-6080
DOI:10.1097/TP.0000000000000888

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