Cytomegalovirus Infection in Pediatric Renal Transplant Recipients: A Single Center Experience

Kim, Mi Jin; You, Ji Hye; Yeh, Hye Ryun; Lee, Jin A; Lee, Joo Hoon

doi:10.3339/jkspn.2017.21.2.75

Cited by 4 publications

(11 citation statements)

References 18 publications

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“…Cytomegalovirus has been reported as the most common opportunistic viral infection following renal transplantation and is associated with increased morbidity, mortality, and graft dysfunction and loss. Fever, malaise, gastritis, enteritis, hepatitis, leukopenia, thrombocytopenia, and pneumonia are some of the clinical features of CMV disease . Increased incidence of CMV infection is seen with CMV‐positive donation to CMV naïve recipients …”

Section: Discussionmentioning

confidence: 99%

Focal segmental glomerulosclerosis associated with acute cytomegalovirus infection in a renal transplant

Wynd

Stewart

Burke

2019

Pediatric Transplantation

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Focal segmental glomerulosclerosis (FSGS) occurring in association with cytomegalovirus (CMV) infection in a renal transplant patient with no previous history of FSGS has rarely been reported. We present a case of a 16‐year‐old renal transplant recipient who developed acute hepatitis, leukopenia, nephrotic syndrome, and progressive renal dysfunction in the setting of acute infection with CMV. The cytomegalovirus infection was successfully treated with IV ganciclovir followed by oral valganciclovir but renal function deterioration and massive proteinuria continued. Features of FSGS were found on two renal allograft biopsies. Plasmapheresis and cyclophosphamide treatment was instituted with no clear effect on disease progress.

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Section: Discussionmentioning

confidence: 99%

Focal segmental glomerulosclerosis associated with acute cytomegalovirus infection in a renal transplant

Wynd

Stewart

Burke

2019

Pediatric Transplantation

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“…In two studies conducted in pediatric patients, the median age at the time of kidney transplantation was 12 20 and 13 years. 6 In the 38 studies that reported the sex distribution of SOT recipients, males accounted for 43.3%-85.5% (Table S9). Distribution of patients according to CMV serostatus was documented in less than half of the retained studies (n = 23 studies, 46.9%).…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…Most studies on the rate of CMV disease in SOT recipients (n = 21/23, 91.3%) reported an incidence ranging between 0% and 19.0%, with results uniformly distributed within the range. [6][7]9,20,25,[30][31][32][33][34]36,37,[42][43][44][45][46][47][48][49][50] Based on five studies, all conducted in kidney recipients, CMV disease occurred within 4-6 months posttransplantation. 7,9,20,44,46 According to Table 1, rates of CMV disease were consistent across the countries of interest except for China, 49 Colombia, 30 South Korea, 25 and Turkey, 47 where rates were lower.…”

Section: F I G U R Ementioning

confidence: 99%

“…18,22,25 Conventional first-line treatment for the prevention of CMV consisted of either intravenous GCV (5 mg/kg 22,33 ) or oral valganciclovir in both adults and pediatric SOT recipients. 6,9,22,30,31,[33][34]38,49,50 Treatment duration ranged between 2 and 3 weeks, with a mean of 15 days in China 58 and 22 days in Brazil. 34,38 Alternative treatments such as acyclovir and its prodrug valacyclovir were also used to prevent the occurrence of CMV in Australia, 7 Brazil, 9 China, 49 Colombia, 43 Mexico, 20 and South Korea.…”

Section: Prevention Strategies For CMV Infection and Diseasementioning

confidence: 99%

“…Prophylaxis and preemptive therapy are both effective in preventing CMV disease in SOT recipients, and there is no agreed‐upon preferred strategy 5 . However, across countries and centers, factors that may trigger the use of prophylaxis include a seronegative recipient for CMV who receives an allograft from a CMV‐seropositive donor (D+/R–) or the use of T‐lymphocyte depletion therapy with antithymocyte globulin (ATG) or alemtuzumab in CMV‐seropositive recipients 6–9 …”

Section: Introductionmentioning

confidence: 99%

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Epidemiology, management, and burden of cytomegalovirus in solid organ transplant recipients in selected countries outside of Europe and North America: A systematic review

Silva

Tokat

Cai

et al. 2023

Transplant Infectious Dis

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BackgroundCytomegalovirus (CMV) is a frequent infectious complication following solid organ transplantation (SOT). Considering significant differences in healthcare systems, a systematic review was conducted to describe the epidemiology, management, and burden of CMV post‐SOT in selected countries outside of Europe and North America.MethodsMEDLINE, Embase, and Cochrane databases were searched for observational studies in SOT recipients across 15 countries in the regions of Asia, Pacific, and Latin America (search period: January 1, 2011 to September 17, 2021). Outcomes included incidence of CMV infection/disease, recurrence, risk factors, CMV‐related mortality, treatment patterns and guidelines, refractory and/or resistant CMV, patient‐reported outcomes, and economic burden.ResultsOf 2708 studies identified, 49 were eligible (n = 43/49; 87.8% in adults; n = 34/49, 69.4% in kidney recipients). Across studies, selection of CMV preventive strategy was based on CMV serostatus. Overall, rates of CMV infection (within 1 year) and CMV disease post‐SOT were respectively, 10.3%–63.2% (9 studies) and 0%–19.0% (17 studies). Recurrence occurred in 35.4%–41.0% cases (3 studies) and up to 5.3% recipients died of CMV‐associated causes (11 studies). Conventional treatments for CMV infection/disease included ganciclovir (GCV) or valganciclovir. Up to 4.4% patients were resistant to treatment (3 studies); no studies reported on refractory CMV. Treatment‐related adverse events with GCV included neutropenia (2%–29%), anemia (13%–48%), leukopenia (11%–37%), and thrombocytopenia (13%–24%). Data on economic burden were scarce. imageConclusionOutside of North America and Europe, rates of CMV infection/disease post‐SOT are highly variable and CMV recurrence is frequent. CMV resistance and treatment‐associated adverse events, including myelosuppression, highlight unmet needs with conventional therapy.

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Molecular Detection and Genotyping of Human Cytomegalovirus in Kidney Transplant Recipients under Ganciclovir Prophylaxis in Iran

et al. 2022

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Introduction: Human Cytomegalovirus (HCMV) infection is one of the most common viral complications in kidney transplant recipients. Although there are effective treatments strategies for the HCMV infection, this infection is still one of the causes of kidney transplant rejection. Methods: A total of 246 kidney transplant recipients participated in this cross-sectional study. Viral DNA was extracted from these plasma samples and the presence of HCMV genome was determined by Semi-nested PCR with specific primers for HCMV B glycoprotein gene. Sanger sequencing analyses were carried out to determine HCMV genotypes and Mega x software was used for nucleotide alignment and construction of a phylogenetic tree. Results: Human cytomegalovirus DNA was detected in 11 (4.47%) recipients. According to the phylogenetic analysis, HCMV gB3 was 50% among kidney transplant recipients, followed by gB4 30% and gB1 20% however, the gB2 genotype was not detected. Conclusions: This study demonstrated that the HCMV infection in our patients is relatively low because all transplant recipients received appropriate prophylaxis, thereby antiviral prophylaxis is recommended for all patients at risk of HCMV infection after kidney transplantation. Also, gB3 was the most predominant genotype among our kidney transplant recipients that was related to the higher rate of prevalence of severe HCMV infections. Moreover, elevated serum creatinine level was detected in patients at the time of detection of HCMV infection.

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Cytomegalovirus Infection in Pediatric Renal Transplant Recipients: A Single Center Experience

Cited by 4 publications

References 18 publications

Focal segmental glomerulosclerosis associated with acute cytomegalovirus infection in a renal transplant

Focal segmental glomerulosclerosis associated with acute cytomegalovirus infection in a renal transplant

Epidemiology, management, and burden of cytomegalovirus in solid organ transplant recipients in selected countries outside of Europe and North America: A systematic review

Molecular Detection and Genotyping of Human Cytomegalovirus in Kidney Transplant Recipients under Ganciclovir Prophylaxis in Iran

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