Current Management Strategies for the Prevention and Treatment of Cytomegalovirus Infection in Pediatric Transplant Recipients

Bueno, J. Trujillo; Ramil, Carmen; Green, Michael

doi:10.2165/00148581-200204050-00001

Cited by 14 publications

(14 citation statements)

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“…These are either prophylaxis of all 'at-risk' patients for a defined period or pre-emptive treatment with ganciclovir of selected 'at-risk' patients based either on laboratory markers indicative of subclinical infection or the presence of specific risk factors. 9 Both acyclovir (ACV) and GCV are effective in the prophylaxis of patients at high risk for CMV disease. 10,11 The adverse effects of GCV, including myelosuppression and nephrotoxicity limit its prophylactic usage for all transplant recipients.…”

mentioning

confidence: 99%

High-dose acyclovir and pre-emptive ganciclovir in prevention of cytomegalovirus disease in pediatric patients following peripheral blood stem cell transplantation

Hazar

Kansoy

Küpesiz

et al. 2004

Bone Marrow Transplant

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mentioning

confidence: 99%

High-dose acyclovir and pre-emptive ganciclovir in prevention of cytomegalovirus disease in pediatric patients following peripheral blood stem cell transplantation

Hazar

Kansoy

Küpesiz

et al. 2004

Bone Marrow Transplant

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“…However, we decided not to use gancyclovir because of possible severe adverse effects [1,8]. We empirically used acyclovir for our patient diagnosed with encephalitis caused by an unknown virus.…”

mentioning

confidence: 99%

Acute cerebellitis in primary human herpesvirus-6 infection

Kato

Kozawa

Teramoto

et al. 2003

European Journal of Pediatrics

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“…1 The risk factors include CMV-seronegative recipients who receive organs from CMV-seropositive donors or CMV-seropositive recipients who received anti-Tcell antibodies, such as anti-thymocyte globulin or muromonab-CD3 (Orthoclone OKT3), for induction of immunosuppression. [2][3][4] Preemptive treatment of CMV infection is a crucial strategy in transplant recipients. Valganciclovir (VGC) has shown its superiority over the intravenous and oral form, ganciclovir, by its convenience, better bioavailability and potency.…”

Section: Ytomegalovirus (Cmv) Infection Is An Importantmentioning

confidence: 99%

Correlation Between Body Mass Index and Leucopenia After Administration of Valganciclovir for Cytomegalovirus Infection in Chinese Cardiac Recipients

Chen

Chang

Hsu

et al. 2007

Circ J

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ytomegalovirus (CMV) infection is an importantcomplication after solid organ transplantation. It is believed that more than 50% of transplant recipients are affected by this troublesome complication, which causes graft failure and mortality if the infection is not treated promptly. 1 The risk factors include CMV-seronegative recipients who receive organs from CMV-seropositive donors or CMV-seropositive recipients who received anti-Tcell antibodies, such as anti-thymocyte globulin or muromonab-CD3 (Orthoclone OKT3), for induction of immunosuppression. [2][3][4] Preemptive treatment of CMV infection is a crucial strategy in transplant recipients. Valganciclovir (VGC) has shown its superiority over the intravenous and oral form, ganciclovir, by its convenience, better bioavailability and potency. 5 It is also an effective prophylaxis for CMV infection in high-risk transplant recipients, 6 and for treatment of CMV retinitis in patients with acquired immunodeficiency syndrome. 7 Several clinical studies have reported that VGC therapy can cause varying degrees of leucopenia, which may counteract the benefits of the therapy. However, the risk factors associated with VGC-induced leucopenia in patients undergoing solid organ transplantation are still not well understood, especially in Oriental recipients. We analyzed the clinical data from before and after VGC therapy in cardiac transplant recipients to clarify the incidence of unexpected leucopenia and the risk factors. Methods PatientsAn institutional review board-approved retrospective chart was conducted from September 2005 to August 2006 and 61 cardiac recipients whose quantitative real-time CMV-polymerase chain reaction (PCR) showed positive results during their monthly check-ups were enrolled. VGC was then prescribed for 3 months at a dosage according to their renal function; 32 developed severe leucopenia after VGC treatment. Leucopenia is defined here as a decrease in the white blood cell (WBC) count greater than 50% of the pre-VGC WBC count or WBC count <3,000 cells/mm 3 . The 61 study subjects were categorized into a leucopenia or non-leucopenia group for further analysis. VGC UsageThe VGC dosage was correlated to the estimated creatinine clearance (900 mg/day if Ccr ≥60 ml/min; 450 mg/day if 60 ml/min >Ccr ≥40 ml/min; 450 mg every other day if 40 ml/min >Ccr ≥25 ml/min; 450 mg twice per week if 25 ml/min >Ccr ≥10 ml/min). We discontinued or reduced the VGC dosage as soon as severe leucopenia developed. Monthly Check-upsThe monthly check-ups for all the cardiac tranplant recipients included complete blood counts, lymphocyte subpopulation, quantitative real-time CMV-PCR, tacrolimus or cyclosporine level, and biochemistry panels. EndomyoCirc J 2007; 71: 968 -972 (Received October 18, 2006; revised manuscript received February 15, 2007; accepted March 5, 2007

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Current Management Strategies for the Prevention and Treatment of Cytomegalovirus Infection in Pediatric Transplant Recipients

Cited by 14 publications

References 0 publications

High-dose acyclovir and pre-emptive ganciclovir in prevention of cytomegalovirus disease in pediatric patients following peripheral blood stem cell transplantation

High-dose acyclovir and pre-emptive ganciclovir in prevention of cytomegalovirus disease in pediatric patients following peripheral blood stem cell transplantation

Acute cerebellitis in primary human herpesvirus-6 infection

Correlation Between Body Mass Index and Leucopenia After Administration of Valganciclovir for Cytomegalovirus Infection in Chinese Cardiac Recipients

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