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Observational Study
. 2020 Apr;22(2):e13232.
doi: 10.1111/tid.13232. Epub 2019 Dec 30.

Evaluation of a change in cytomegalovirus prevention strategy following pediatric solid organ transplantation

Scott Pangonis  1 , Grant Paulsen  1 , Heidi Andersen  1 , Francisco Flores  1 , Alexander Miethke  1 , Anna Peters  1 , Samuel Kocoshis  1 , Danielle Lazear  1 , BreAnn Garr  1 , Marc Schecter  1 , Clifford Chin  1 , Trina Hemmelgarn  1 , Lara Danziger-Isakov  1
Affiliations
Observational Study

Evaluation of a change in cytomegalovirus prevention strategy following pediatric solid organ transplantation

Scott Pangonis et al. Transpl Infect Dis. 2020 Apr.

Abstract

Background: An optimal cytomegalovirus (CMV) prevention strategy following solid organ transplantation (SOT) remains uncertain. This study reports on the rates of CMV events following a change in a local prevention guideline involving increased surveillance, earlier transition to oral valganciclovir, and decreased CMV-immunoglobulin use.

Methods: A retrospective cohort study utilizing historical controls evaluated the rates of CMV invasive disease pre- and post-intervention among pediatric heart, liver, and kidney recipients. Outcomes were recorded for the 4 years pre- and post-intervention, 9/2009-10/2017. Logistic regression was used to estimate the risk of a CMV event.

Results: There was no difference in the rates of CMV invasive disease between the two study groups (P = 1). An increase in the detection of CMV events occurred (P = .04), predominantly asymptomatic CMV infection. This increase was independently associated with increased surveillance testing among high-risk heart and liver recipients, aOR 1.08 (1.06-1.12). Surprisingly, 28.9% of CMV events occurred during antiviral prophylaxis.

Conclusions: Modification of the local CMV prevention guideline did not result in an increase in CMV invasive disease. CMV events occurred while on prophylaxis, highlighting a potential difference from adult solid organ transplant (SOT) and emphasizing the potential need for monitoring on prophylaxis in the pediatric population.

Keywords: cytomegalovirus; pediatric; prevention; solid organ transplantation.

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References

REFERENCES

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