Antimicrobial Stewardship Program, Center for Healthcare Quality & Analytics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Pediatric IDEAS Research Group of the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Am J Transplant. 2022 Dec;22(12):3012-3020. doi: 10.1111/ajt.17171. Epub 2022 Aug 26.
Prophylaxis with valganciclovir (VGCV) is used routinely to prevent cytomegalovirus (CMV) infections in at-risk pediatric solid organ transplant (SOT) recipients. However, the rate and factors associated with toxicities in this population are not well-described. We conducted a retrospective cohort study of children undergoing SOT at our hospital from January 2012-June 2018. We evaluated the frequency of hematologic and renal toxicities from day 15 through 1-year post-SOT in relation to antiviral exposures, focused on VGCV prophylaxis. Marginal rate models were used to determine the risk of kidney injury and neutropenia in relation to VGCV prophylaxis. Among 281 SOTs, VGCV prophylaxis was administered on 20.1% of all follow-up days. The incidence rates of kidney injury, leukopenia, and neutropenia were significantly higher during VGCV prophylaxis compared to when no antiviral agents were given. Using multivariable marginal rate models, receipt of VGCV prophylaxis was associated with development of kidney injury (rate ratio [RR] 1.79, 95% confidence interval [CI]: 1.22-2.65) and neutropenia (RR 4.82, 95% CI: 3.08-7.55). VGCV dosing did not impact the development of kidney injury or neutropenia. Toxicities are common with VGCV prophylaxis in pediatric SOT recipients.
更昔洛韦（VGCV）预防疗法被常规用于预防高危儿科实体器官移植（SOT）受者的巨细胞病毒（CMV）感染。然而，该人群中与毒性相关的发生率和因素尚未得到充分描述。我们对 2012 年 1 月至 2018 年 6 月在我院接受 SOT 的儿童进行了一项回顾性队列研究。我们评估了与抗病毒暴露（重点是 VGCV 预防疗法）相关的 SOT 后第 15 天至 1 年期间血液学和肾脏毒性的频率。边缘率模型用于确定与 VGCV 预防疗法相关的肾损伤和中性粒细胞减少症的风险。在 281 例 SOT 中，VGCV 预防疗法在所有随访天数中的占比为 20.1%。与未给予抗病毒药物相比，VGCV 预防疗法期间肾损伤、白细胞减少症和中性粒细胞减少症的发生率明显更高。使用多变量边缘率模型，VGCV 预防疗法与肾损伤（率比 [RR] 1.79，95%置信区间 [CI]：1.22-2.65）和中性粒细胞减少症（RR 4.82，95% CI：3.08-7.55）的发展相关。VGCV 剂量对肾损伤或中性粒细胞减少症的发展没有影响。VGCV 预防疗法在儿科 SOT 受者中常见毒性。
