Cytomegalovirus (CMV) infection is common in pediatric renal transplant recipients and approaches to prevention vary. In this study, characteristics of CMV infection after universal prophylaxis were analyzed.
Methods: A retrospective cohort of 93 pediatric kidney allograft recipients between 2008-2013, including 17-18 follow-up clinic visits per patient over two years, was analyzed. Clinical data included: demographics, immunosuppressive therapy, viral infection and disease, and biopsy results. CMV donor serostatus groups (D+ and D-) and donor/recipient serostatus groups (D+/R+, D+/R-, D-/R+, D-/R-) were compared for CMV infection and disease, EBV and BKV viral loads, and acute rejection using the one-way ANOVA.
Results: Among the 93 patients, 20.4% (19) were D+/R+, 40.9% (38) D+/R-, 9.7% (9) D-R+, and 29% (27) D-R-. Groups had no significant differences for patient demographics or immunosuppression. All patients received valganciclovir prophylaxis for at least 60 days, followed by prospective viral surveillance. Comparing the CMV donor serostatus groups, in the D+ group , 20/57 (35%) had CMV infection compared to 2/36 (5.6%) in the D- group (p=0.003). CMV disease occurred in 7/57 (12.3%) of D+ patients, compared to 1/36 (2.8%) of D- patients (p=0.23). Comparing the four donor/recipient serostatus groups, D-/R+ and D-/R- groups had a shorter duration until CMV clearance (mean±SD) at 26.5 ± 7.8 and 35 days, respectively, compared to the D+/R+ and D+/R- groups at 44.4 ± 29.8 and 86 ± 106.3 days. The D+/R- group exhibited the shortest interval until CMV viral loads were greater than 100 IU/mL at an average of 140.2 ±137.3 days and was the only group with children whose kidney biopsies demonstrated either borderline or cellular rejection (10.5%, 4/38 patients). There was a trend toward higher incidence of EBV and BKV viremia among CMV D+/R- patients.
Conclusion: The results of this study show an increased incidence of CMV infection in the D+ group, and increased acute rejection in the CMV D+/R- group. Although not statistically significant, pediatric CMV D+ patients also more often had CMV disease, earlier and longer duration of viremia, and EBV and/or BKV viremia, despite universal CMV antiviral prophylaxis and surveillance.