Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May;26(3):e14220.
doi: 10.1111/petr.14220. Epub 2022 Jan 6.

CMV infection and management among pediatric solid organ transplant recipients

Kevin J Downes  1   2   3 , Anna Sharova  2 , Craig L K Boge  2 , Daniel Vader  2   4 , Marina Mitrou  2 , Molly Hayes  5 , Despoina M Galetaki  2 , Lauren Gianchetti  2 , Laura A Vella  1   3 , Yun Li  2   3   4
Affiliations

CMV infection and management among pediatric solid organ transplant recipients

Kevin J Downes et al. Pediatr Transplant. 2022 May.

Abstract

Background: Cytomegalovirus (CMV) is an important cause of morbidity and mortality in pediatric solid organ transplant (SOT) recipients. However, the impact of asymptomatic CMV infections (ie, DNAemia) on clinical outcomes is not well established.

Methods: We performed a retrospective cohort study of children undergoing first SOT at our institution from January 2012 to June 2018. We evaluated the epidemiology of CMV infections and performed multivariable Cox regression to assess the association between CMV DNAemia without disease or CMV disease (syndrome or end-organ disease) on negative outcomes (death, re-transplantation, or moderate/severe rejection) within the first year after SOT.

Results: Among 271 individuals, 43 (15.9%) developed ≥1 CMV infection during the first year after SOT. There were 56 unique CMV infections including 14 episodes of CMV disease. In 167 patients offered CMV prophylaxis, only 8 (4.8%) developed their first CMV DNAemia episode while on prophylaxis 32 developed CMV DNAemia after prophylaxis completion; only 1 episode of CMV disease occurred while on antiviral prophylaxis. When accounting for receipt of ATG, oral steroids, and number of immunosuppressives on a given day, CMV disease was more strongly associated with negative outcomes (Hazard Ratio (HR): 3.28, 95% CI: 0.73-14.64; p = .12) than CMV DNAemia without disease (HR 1.42, 95% CI: 0.19- 10.79; p = .74), although not to a statistically significant degree.

Conclusions: Most CMV infections occurred after completion of antiviral prophylaxis. CMV disease was more strongly associated with negative outcomes than asymptomatic CMV DNAemia and should be the focus of CMV prevention practices.

Keywords: cytomegalovirus; outcome; prophylaxis; viral infection.

PubMed Disclaimer

References

REFERENCES

    1. Paulsen G, Cumagun P, Mixon E, Fowler K, Feig D, Shimamura M. Cytomegalovirus and Epstein-Barr virus infections among pediatric kidney transplant recipients at a center using universal Valganciclovir Prophylaxis. Pediatr Transplant. 2019;23(3):e13382.
    1. Keskinoglu A, Bulut IK, Taner S, Turkes AZ, Kabasakal C. cytomegalovirus experience in pediatric kidney transplantation in 26 years’ time. Transplant Proc. 2020;52(10):3186-3191.
    1. Hocker B, Zencke S, Krupka K, et al. Cytomegalovirus infection in pediatric renal transplantation and the impact of chemoprophylaxis with (val-)ganciclovir. Transplantation. 2016;100(4):862-870.
    1. Danziger-Isakov LA, Worley S, Michaels MG, et al. The risk, prevention, and outcome of cytomegalovirus after pediatric lung transplantation. Transplantation. 2009;87(10):1541-1548.
    1. Furuichi M, Fujiwara T, Fukuda A, Kasahara M, Miyairi I. Fulminant hepatic failure as a risk factor for cytomegalovirus infection in children receiving preemptive therapy after living donor liver transplantation. Transplantation. 2016;100(11):2404-2409.

MeSH terms

Substances