Paulsen Grant, Cumagun Pia, Mixon Emily, Fowler Karen, Feig Daniel, Shimamura Masako
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Pediatr Transplant. 2019 May;23(3):e13382. doi: 10.1111/petr.13382. Epub 2019 Feb 20.
CMV is associated with adverse effects in renal transplant recipients. The objective of this study was to characterize the incidence and timing of CMV and EBV infections in relation to valGCV prophylaxis in a pediatric renal transplant cohort.
Retrospective cohort of pediatric renal transplant patients given universal valGCV prophylaxis and universal viral surveillance was evaluated. Demographics, prophylaxis, acute rejection, and CMV and EBV infections were abstracted.
A total of 92 pediatric renal allograft recipients, 2008-2013, were included. One or more viral infections developed in 77/92 (83.7%) of the patients. EBV was the most common in 62/92 (67%) patients, irrespective of valGCV (82% of episodes occurring on valGCV). CMV DNAemia occurred in 30/92 (33%) patients, 14 episodes (47%) occurring on valGCV. Incidence of breakthrough CMV on prophylaxis was 15% and was associated with persistent DNAemia (OR 7.8, CI:1.6-32.9, P < 0.02). CMV tissue-invasive disease was not seen. CMV syndrome occurred in 10% of the cohort, only in CMV D+ patients, and only one symptomatic breakthrough infection required treatment. Out of 92, 21 (23%) had simultaneous co-infections with 2-3 viruses.
Viral infections in pediatric renal transplant recipients receiving universal valGCV prophylaxis were common. EBV infections were not reduced by valGCV prophylaxis, and nearly half of CMV infections occurred on valGCV. Symptomatic CMV infection while on prophylaxis was rare. valGCV prophylaxis may prevent symptomatic CMV infection but not EBV infection, and frequent CMV surveillance in pediatric renal transplant recipients on prophylaxis may not be necessary.
巨细胞病毒（CMV）与肾移植受者的不良反应相关。本研究的目的是在一个儿科肾移植队列中，描述CMV和EB病毒（EBV）感染的发生率及时间，并与缬更昔洛韦（valGCV）预防治疗进行关联分析。
对接受普遍valGCV预防治疗和普遍病毒监测的儿科肾移植患者进行回顾性队列研究。收集人口统计学资料、预防治疗情况、急性排斥反应以及CMV和EBV感染情况。
纳入了2008年至2013年期间的92例儿科肾移植受者。77/92（83.7%）的患者发生了一种或多种病毒感染。EBV是最常见的，在62/92（67%）的患者中出现，无论是否使用valGCV（82%的发作发生在使用valGCV期间）。30/92（33%）的患者出现了CMV血症，14例发作（47%）发生在使用valGCV期间。预防治疗期间突破性CMV感染的发生率为15%，且与持续性病毒血症相关（比值比7.8，可信区间：1.6 - 32.9，P < 0.02）。未观察到CMV组织侵袭性疾病。CMV综合征在该队列中的发生率为10%，仅在CMV D+患者中出现，且只有1例有症状的突破性感染需要治疗。92例患者中，21例（23%）同时合并2 - 3种病毒感染。
接受普遍valGCV预防治疗的儿科肾移植受者中病毒感染很常见。valGCV预防治疗并未降低EBV感染率，且近一半的CMV感染发生在使用valGCV期间。预防治疗期间有症状的CMV感染很少见。valGCV预防治疗可能预防有症状的CMV感染，但不能预防EBV感染，对于接受预防治疗的儿科肾移植受者，频繁的CMV监测可能没有必要。
