1564. Lower Rates of Epstein-Barr Virus (EBV) Viremia in Pediatric Solid Organ Transplant (SOT) Recipients Who Received Valganciclovir Prophylaxis
Session: Poster Abstract Session: Viruses and Bacteria in Immunocompromised Patients
Friday, October 5, 2018
Room: S Poster Hall

Background: Antiviral prophylaxis to prevent PTLD remains controversial, but some data suggest that valganciclovir or ganciclovir ([val]ganciclovir) use in EBV high-risk pediatric renal transplants reduces EBV viremia.  We evaluated the impact of [val]ganciclovir on EBV viremia and post-transplant lymphoproliferative disease (PTLD) in pediatric non-renal SOT recipients. 

Methods:   Retrospective study of 100 patients who underwent a first heart, liver, lung, intestine, or multivisceral SOT between 11/2013 and 11/2016 at Boston Children’s Hospital who survived without re-transplantation for at least 30 days.  Data collected included EBV donor/recipient serostatus, donor’s age > 2 years-old (to avoid misclassification of EBV risk due to maternal antibody), antiviral use ([val]ganciclovir or acyclovir), time to EBV viremia (>1000 copies/mL by whole blood PCR), and time to development of PTLD.  EBV high-risk patients were those with donor EBV positive [D+]/recipient EBV negative [R–] serologies; intermediate-risk were EBV R+; low-risk were EBV D–/R–. Time-to-event analysis using the Kaplan-Meier method was performed and significance (p=0.05) was evaluated using the log-rank test.

Results:   High (n=45) or intermediate (n=27) EBV risk was associated with increased EBV viremia (p=0.007, Table).  EBV viremia was significantly decreased in the subgroup of high-risk patients with donors > 2 years-old who received [val]ganciclovir versus those who received no antiviral (n=23, n=4, p=0.03, Fig.1). Most PTLD cases (8/9) occurred in the high-risk group (p=0.03, Fig. 2). Overall, patients who received [val]ganciclovir had less PTLD than those who did not (p=0.03), but this was not significant in the high-risk subgroup (p=0.14, Fig.3).

Conclusion: Lower rates of EBV viremia occurred in high EBV risk transplant recipients who received [val]ganciclovir, possibly by preventing primary EBV infection. Recipients with high EBV risk have the highest rate of PTLD. 

 

cases=100

EBV Risk

Outcome

Organ

Unknown

Low

Intermediate

High

Viremia

PTLD

Heart

5

8

13

20

18

5

Liver

 

11

10

18

6

2

Lung

1

1

4

4

6

2

Intestine

 

1

 

 

0

 

Multivisceral

1

 

 

 

1

 

Dual organ

 

 

 

3

1

 

Total

7

21

27

45

43

9

 

 

 

 

 

 

 

Antiviral

 

 

 

 

 

 

No Antiviral

 

6

 

6

5

2

Acyclovir

2

1

3

8

7

3

[Val]ganciclovir

5

13

24

31

31

4

 

 

 

 

 

 

 

Outcome

 

 

 

 

 

 

Viremia

2

2

14

25

 

9

PTLD

 

1

 

8

9

 

 

 

 

 

 

 

Elizabeth A Moulton, MD, PhD1, Manjiree Karandikar, MD, MBS2, Sheila Bond, MD3, Sandra Burchett, MD, MS1, Tanvi Sharma, MD, MPH2 and Francisco M Marty, MD4, (1)Boston Children's Hospital, Boston, MA, (2)Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, (3)Brigham and Woman's Hospital, Boston, MA, (4)Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA

Disclosures:

E. A. Moulton, None

M. Karandikar, None

S. Bond, None

S. Burchett, None

T. Sharma, None

F. M. Marty, Merck: Consultant and Investigator , Consulting fee , Research support and Speaker honorarium . Astellas: Consultant and Investigator , Consulting fee and Research support . Chimerix: Consultant and Investigator , Consulting fee and Research support . Fate Therapeutics: Consultant , Consulting fee . GlaxoSmithKline: Consultant , Consulting fee . LFB: Consultant , Consulting fee . Roche Molecular Diagnostics: Consultant , Consulting fee . Shire: Consultant and Investigator , Consulting fee and Research support .

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.