Cytomegalovirus (CMV) is a major cause for concern among transplant patients. Some pediatric centres employ a prevention strategy with antiviral prophylaxis and polymerase chain reaction (PCR) to monitor for CMV DNAemia in the post-transplant period. This study examines the burden of CMV DNAemia and time to such events among renal transplant patients within the first year after transplantation.
We conducted a retrospective review of renal transplant patients (< 18 years) who were transplanted between 01/2007 and 12/2012. Patients who were CMV donor-seropositive (D+) and recipient seronegative (R-) received prophylaxis with ganciclovir (IV) for 2 weeks followed by valganciclovir or oral acyclovir for 10 weeks and low risk (D+R+ or D-R+) patients received valganciclovir for 12 weeks, with modifications based on age and clinical status. Clinical and laboratory data were obtained from the medical records and laboratory databases.
Among 121 patients, the median age at transplant was 12.6 years (range 6 months – 17.8 years); M:F ratio 1:0.57. Forty-two patients (34.7%) received anti-T cell globulins. CMV serostatus: D+R- 27 (23.1%); D-R+ and D+R+ 35 (29.9%) and D-R- 55 (47%). CMV DNAemia was detected in 18 patients (14.8%) during the first post-transplant year. Among these patients, 8 were D+R- and 8 were D-R+ or D+R+. Median time to first positivity was 134 days (range 0-188 days). Among patients whose first positive PCR was after 3 months post-transplant, median time to positivity was 53 days (range 32-98 days) after the end of prophylaxis.
CMV DNAemia while on prophylaxis was uncommon, occurring 1 in 40 transplanted patients. Routine monitoring while on prophylaxis may be no longer warranted. Studies are needed to determine the optimal indications for CMV PCR testing while on prophylaxis.
A. Petrich, None
A. Williams, None
D. Hebert, None
V. Langlois, None
U. Allen, None