Department of Pediatric Nephrology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Department of Pediatrics, Matsuyama Red Cross Hospital, Ehime, Japan.
Clin Exp Nephrol. 2021 May;25(5):531-536. doi: 10.1007/s10157-021-02020-z. Epub 2021 Jan 27.
There are two approaches for treating cytomegalovirus (CMV) infection occurring after kidney transplantation (KTx). One is preemptive therapy in which treatment is started after confirming positive CMV antigenemia using periodic antigenemia assay. The other approach is prophylactic therapy in which oral valganciclovir (VGCV) is started within 10 days after KTx and continued for 200 days. The Transplantation Society guidelines recommend prophylactic therapy for high-risk (donor's CMV-IgG antibody positive and recipient's negative) pediatric recipients. However, the adequate dose and side effects of VGCV are not clear in children, and there is no sufficient information about prophylaxis for Japanese pediatric recipients.
A single-center retrospective analysis was conducted on case series of high-risk pediatric patients who underwent KTx and received oral VGCV prophylaxis at the Department of Pediatric Nephrology, Tokyo Women's Medical University, between August 2018 and March 2019. Data were collected using medical records.
The dose of administration was 450 mg in all the study patients (n = 5). Reduction or discontinuation was required in four of five patients due to adverse events, which included neutropenia in one patient, anemia in two patients, and neutropenia and digestive symptoms in one patient. Late-onset CMV disease occurred in all patients. No seroconversion was observed during prophylaxis.
Our preliminary study suggests that the dosage endorsed by The Transplantation Society may be an overdose for Japanese pediatric recipients. Further studies are required to examine the safety and efficacy of VGCV prophylaxis in Japanese pediatric recipients.
治疗肾移植（KTx）后发生的巨细胞病毒（CMV）感染有两种方法。一种是抢先治疗，即在使用定期抗原检测法确认 CMV 抗原血症阳性后开始治疗。另一种方法是预防性治疗，即在 KTx 后 10 天内开始口服缬更昔洛韦（VGCV），并持续 200 天。移植学会指南建议对高风险（供体 CMV-IgG 抗体阳性，受体阴性）儿科受者进行预防性治疗。然而，VGCV 在儿童中的适当剂量和副作用尚不清楚，并且针对日本儿科受者的预防措施信息不足。
对 2018 年 8 月至 2019 年 3 月期间在东京女子医科大学小儿肾病科接受 KTx 并接受口服 VGCV 预防治疗的高危儿科患者进行了单中心回顾性病例系列分析。使用病历收集数据。
所有研究患者（n=5）的给药剂量均为 450mg。由于不良反应，五名患者中有四名需要减少或停止用药，其中一名患者出现中性粒细胞减少症，两名患者出现贫血，一名患者出现中性粒细胞减少症和消化系统症状。所有患者均发生迟发性 CMV 疾病。在预防过程中未观察到血清转化。
我们的初步研究表明，移植学会推荐的剂量对日本儿科受者可能是过量的。需要进一步研究来检查 VGCV 预防在日本儿科受者中的安全性和有效性。
