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. 2011 Jan 27;91(2):245-50.
doi: 10.1097/TP.0b013e3181ffffd3.

24 weeks of valganciclovir prophylaxis in children after renal transplantation: a 4-year experience

Andres F Camacho-Gonzalez  1 , Julie Gutman, Leonard C Hymes, Traci Leong, Joseph A Hilinski
Affiliations

24 weeks of valganciclovir prophylaxis in children after renal transplantation: a 4-year experience

Andres F Camacho-Gonzalez et al. Transplantation. .

Abstract

Background: Cytomegalovirus (CMV) is the most common opportunistic infection after solid-organ transplant. Valganciclovir prophylaxis significantly reduces disease, but limited data are available on its use in children. Recently, an increase in delayed-onset CMV disease has been noted with some arguing that longer prophylaxis may decrease late-onset disease.

Methods: Single-center, retrospective analysis of pediatric renal transplant patients receiving 24 weeks valganciclovir prophylaxis (15 mg/kg/day, maximum 900 mg/day) from January 2004 to December 2008, aiming to measure the incidence of CMV disease and toxicity of valganciclovir.

Results: We enrolled 111 patients, 60% males, 46% African Americans, and median age at transplant 14.5 years (range 1.4-20.4 years). Sixty-nine percent of donors and 44% of recipients were seropositive pretransplant. Median duration of valganciclovir use was 5.9 months (range 0.5-24 months). CMV viremia and disease occurred in 27% and 4.5%, respectively. All patients with disease presented after prophylaxis ended and all were D+/R-. Thymoglobulin use (P = 0.04) and positive donor CMV status (P = 0.02) were associated with a higher risk of CMV viremia. Twenty-four percent had hematologic toxicity directly associated with valganciclovir.

Conclusions: Valganciclovir use in children was effective as prophylaxis against CMV disease; no children at our institution developed disease while on therapy. Our regimen of 24 weeks of prophylaxis was associated with a lower rate of late-onset disease than previous reports with 12-week regimens. Further controlled studies should be considered to compare longer versus shorter periods of prophylaxis and dose reductions and their impact on prevention of late-onset disease, resistance, cost, and toxicity.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Patient flow-chart. D, donor; R, recipient.
FIGURE 2
FIGURE 2
Time to development of cytomegalovirus (CMV) viremia from transplantation.
See this image and copyright information in PMC

References

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