Burden of cytomegalovirus DNAemia among pediatric renal transplant patients on antiviral prophylaxis: A hospital-based analysis.
Adolescent
Antiviral Agents
/ therapeutic use
Biomarkers
/ blood
Child
Child, Preschool
Cost of Illness
Cytomegalovirus Infections
/ diagnosis
DNA, Viral
/ blood
Drug Therapy, Combination
Female
Hospitals, Pediatric
Humans
Infant
Kidney Transplantation
Male
Postoperative Complications
/ diagnosis
Retrospective Studies
Viremia
/ diagnosis
cytomegalovirus
pediatric
polymerase chain reaction
Journal
Pediatric transplantation
ISSN: 1399-3046
Titre abrégé: Pediatr Transplant
Pays: Denmark
ID NLM: 9802574
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
received:
22
01
2019
revised:
02
11
2019
accepted:
24
11
2019
pubmed:
1
1
2020
medline:
27
1
2021
entrez:
1
1
2020
Statut:
ppublish
Résumé
We examined the burden of CMV DNAemia and time to such events among renal transplant patients receiving CMV prophylaxis. We targeted the first year after transplantation, with the primary focus being on the first 3 months. We conducted a retrospective review of renal transplant patients (<18 years) who were transplanted and followed at our center between January 2007, and December 2017. Clinical and laboratory data were obtained from the medical records and laboratory databases. Among 141 patients, the median age at transplant was 12.7 years (range 0.87-17.83 years). CMV DNAemia was detected in 33 of 77 patients eligible for prophylaxis (42.9%; 95% CI 31.6-54.6) during the first post-transplant year. Proportionately more D+R- patients were present among patients with DNAemia compared with those without DNAemia (15/38, 39.5% vs 16/103, 15.5%, P = .005). Median time to first positivity was 134 days (range 0-304 days). Eight patients had a positive PCR during the first 3 months (5.7% of all patients). Among those eligible for prophylaxis, 6.5% had DNAemia during the first 3 months while on prophylaxis. Among patients whose first positive PCR was after 3 months post-transplant, the median time to positivity was 52 days (range 13-214 days) after the end of prophylaxis. Breakthrough CMV DNAemia was documented among children receiving antiviral prophylaxis. While routine monitoring while on prophylaxis might not be warranted for the majority of patients, studies are needed to determine the optimal indications for CMV PCR testing while on prophylaxis.
Substances chimiques
Antiviral Agents
0
Biomarkers
0
DNA, Viral
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13650Informations de copyright
© 2019 Wiley Periodicals, Inc.
Références
Razonable RR, Humar A. Practice ASTIDCo. Cytomegalovirus in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):93-106.
Griffiths PD, Emery VC. Taming the transplantation troll by targeting terminase. N Engl J Med. 2014;370(19):1844-1846.
Stern M, Hirsch H, Cusini A, et al. Cytomegalovirus serology and replication remain associated with solid organ graft rejection and graft loss in the era of prophylactic treatment. Transplantation. 2014;98(9):1013-1018.
Iragorri S, Pillay D, Scrine M, Trompeter RS, Rees L, Griffiths PD. Prospective cytomegalovirus surveillance in paediatric renal transplant patients. Pediatr Nephrol. 1993;7:55-60.
Smith JM, Corey L, Bittner R, et al. Subclinical viremia increases risk for chronic allograft injury in pediatric renal transplantation. J Am Soc Nephrol. 2010;21(9):1579-1586.
Höcker B, Zencke S, Krupka K, et al. Cytomegalovirus infection in pediatric renal transplantation and the impact of chemoprophylaxis with (val-)ganciclovir. Transplantation. 2016;100(4):862-870.
Kotton CN, Kumar D, Caliendo AM, et al. The third international consensus guidelines on the management of cytomegalovirus in solid organ transplantation. Transplantation. 2018;102:900-931.
Madan RP, Campbell AL, Shust GF, et al. A hybrid strategy for the prevention of cytomegalovirus-related complications in pediatric liver transplantation recipients. Transplantation. 2009;87(9):1318-1324.
Lisboa LF, Preiksaitis JK, Humar A, Kumar D. Clinical utility of molecular surveillance for cytomegalovirus after antiviral prophylaxis in high-risk solid organ transplant recipients. Transplantation. 2011;92(9):1063-1068.
Boillat Blanco N, Pascual M, Venetz JP, Nseir G, Meylan PR, Manuel O. Impact of a preemptive strategy after 3 months of valganciclovir cytomegalovirus prophylaxis in kidney transplant recipients. Transplantation. 2011;91(2):251-255.
van der Beek MT, Berger SP, Vossen ACTM, et al. Preemptive versus sequential prophylactic-preemptive treatment regimens for cytomegalovirus in renal transplantation: comparison of treatment failure and antiviral resistance. Transplantation. 2010;89(3):320-326.
Lin A, Worley S, Brubaker J, et al. Assessment of cytomegalovirus hybrid preventative strategy in pediatric heart transplant patients. J Pediatric Infect Dis Soc. 2012;1(4):278-283.
Altona RealStar CMV PCR Kit 1.0 (Hamburg, Germany). https://www.altona-diagnostics.com/en/products/reagents-140/reagents/realstar-real-time-pcr-reagents/realstar-real-time-pcr-kits-ce.html
Humar A, Michaels M. American Society of Transplantation recommendations for screening, monitoring and reporting of infectious complications in immunosuppression trials in recipients of organ transplantation. Am J Transplant. 2006;6:262-274.
Ljungman P, Boeckh M, Hirsch HH, et al. Definitions of cytomegalovirus infection and disease in transplant patients for use in clinical trials. Clin Infect Dis. 2017;64:87-91.
Paya CV. Indirect effects of CMV in the solid organ transplant patient. Transpl Infect Dis. 1999;1(Suppl 1):8-12.
Chaiyapak T, Borges K, Williams A, et al. Incidence of cytomegalovirus DNAemia in pediatric kidney transplant recipients after cessation of antiviral prophylaxis. Transplantation. 2018;102(8):1391-1396.
Höcker B, Zencke S, Pape L, et al. Impact of everolimus and low-dose cyclosporine on cytomegalovirus replication and disease in pediatric renal transplantation. Am J Transplant. 2016;16:921-929.
Danziger-Isakov LA, Worley S, Michaels MG, et al. The risk, prevention, and outcome of cytomegalovirus after pediatric lung transplantation. Transplantation. 2009;87:1541-1548.
Pellett Madan R, Allen UD, Green M, et al. Pediatric transplantation case conference: Update on cytomegalovirus. Pediatr Transplant. 2018;22(7):e13276.