Incidence of Cytomegalovirus DNAemia in Pediatric Kidney Transplant Recipients After Cessation of Antiviral Prophylaxis

Abstract

This study demonstrates a high incidence of CMV infection after cessation of antiviral prophylaxis. These results support extension of antiviral prophylaxis beyond 3 months and/or intensive viral load monitoring to reduce risk of CMV infection in D + R- and R+ children, especially those receiving antithymocyte globulin.

Cytomegalovirus infection and allograft rejection among pediatric heart transplant recipients in the era of valganciclovir prophylaxis

“…We noted an overall incidence of CMV infection of 34% in our cohort during the study period, consistent with prior reports 6,16‐19 . Breakthrough CMV infection was seen in 10%‐14% of individuals while on VGC prophylaxis, with no notable difference between HR and IR cohorts, similar to previously reported studies 7 .…”

Common Viral Infections In Children After Kidney Transplantation

“…3,10,11 Universal antiviral prophylaxis can prevent several common viral infections, including CMV, EBV, VZV and HSV infections, during the prophylaxis period, but these viruses may occur after the cessation of antiviral prophylaxis. 3,12 Most cases of polyomavirus-associated nephropathy (PVAN) occur in the 1 st year post kidney transplantation. 2 In addition, community-acquired respiratory viruses such as influenza, parainfluenza, RSV, adenovirus and foodborne gastroenteritis due to rotavirus and norovirus are still common and occur at any time of exposure.…”

“…3,16 A retrospective study in children demonstrated that children who received antithymocyte globulin for induction therapy developed CMV DNAemia within the first 3 months after cessation of universal antiviral prophylaxis compared with those who received anti-interleukin-2 (IL-2). 12…”

“…[23][24][25] Furthermore, the risk of DNAemia is highest during the 3 months after antiviral prophylaxis cessation, so surveillance needs to be continued during this time period. 12,14 For preemptive therapy, antiviral therapy is started when QNAT detects CMV before the development of CMV disease. 14 Unfortunately, the optimal CMV viral load threshold to initiate therapy is still controversial because of the variability in diagnostic tests.…”

Cytomegalovirus DNAemia in kidney transplant recipients after cessation of standard antiviral prophylaxis; estimated rate on Thai cases and implication on efficacy of prophylaxis

“…This observed rate can confirm that the standard prophylaxis partially prevent CMV and the efficacy is still less than a half of all prophylaxis attempts. It should be noted that the possibility for CMV disease development among renal recipients with CMV DNAemia is about 11.4% (2). Hence, there is a need for evaluation of CMV DNAemia in the renal transplant recipients after cessation of standard antiviral prophylaxis.…”