Objectives: Cytomegalovirus (CMV) is an opportunistic infection that can lead to significant complications post-transplant. Purpose of this study was to evaluate the use of valganciclovir (VGC) prophylaxis and impact of dose adjustments on CMV infection in pediatric solid organ transplant (SOT) recipients.

Methods: A single-center, retrospective review of 399 pediatric kidney, liver, and heart transplant recipients from 2010 to 2015 was performed to assess incidence of CMV infection and evaluate our center's CMV prophylaxis protocol of VGC 15 mg/kg (maximum 900 mg) orally once daily for 6 months post-transplant for CMV-positive donors and/or recipients. Patient demographic data, CMV serostatus, immunosuppression regimen, anti-viral prophylaxis, CMV viremia development and treatment data were collected. Multivariate logistic regression analysis of the data was performed to determine risk factors associated with CMV viremia.

Results: Of the 399 patients, 85 (21.3%) developed CMV viremia with protocol-driven prophylaxis within one year post-transplant. Of those with viremia, 34 (40%) were primary infections developed while holding VGC prophylaxis, 27 (32%) were developed while receiving VGC prophylaxis, and 24 (28%) were developed after completion of 6 months of VGC prophylaxis. Analysis of the data revealed a significantly higher rate of CMV viremia in liver (HR 2.34, CI 1.39-3.95) and heart (HR 1.94, CI 1.10-3.42) transplant recipients as compared to kidney. Overall 48 (22.2%) patients experienced significant adverse effects while on VGC prophylaxis (mainly neutropenia) and subsequent dose reductions were made to their regimen. Multivariate analysis found the risk for CMV viremia was 2-fold higher (HR 2.16, CI 1.12 – 4.16) in patients when the VGC dose was reduced for side effects. Overall 6 patients developed ganciclovir-resistant CMV viremia requiring treatment with foscarnet and/or cidofovir.

Conclusions: CMV viremia is common post-transplant in pediatric SOT recipients. Dose reduction of VGC prophylaxis for adverse effect management places patients at an increased risk for CMV viremia suggesting other means of adverse effect management should be used in this population. Long term impact of early prophylaxis and aggressive treatment of CMV viremia in pediatric transplant recipients need further study.

CITATION INFORMATION: Nance G., Serluco A., Deshpande S., Garro R., George R., Kelleman M., Liverman R. Cytomegalovirus Infection in Pediatric Solid Organ Transplant Recipients and Role of Prophylaxis Am J Transplant. 2017;17 (suppl 3).

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