Purpose: To evaluate the safety and efficacy of oral valganciclovir in treating cytomegalovirus (CMV) infections in pediatric intestinal transplant recipients (pITR).

Methods: This retrospective review included all pITR treated with valganciclovir for CMV infections from January 1^st, 2004 through December 31^st, 2016. The primary outcome was resolution of CMV viremia. Secondary outcomes included time to resolution of viremia, relapse rate, incidence of CMV resistance, incidence of rejection, graft loss, death, and hematologic adverse effects.

Results: Of 214 pITR transplanted 40 patients had CMV infections. Of those, ten patients were treated with valganciclovir at our center. One patient was lost to follow-up while being treated for CMV and was not included in the final analysis. For the nine patients analyzed, six were female and the mean age was 2.4 years (SD 3.7). The mean dose of valganciclovir was 14.3mg/kg (SD 0.82) twice daily. This was substantially less than current pediatric prophylactic dosing recommendations. Eight (89%) patients had resolution of CMV viremia. The median length of time to clearance of viremia was 37 days (range: 7,95). Two patients had at least one episode of relapse. One was not treated as the patient remained asymptomatic and had low grade viremia. The other cleared viremia with valganciclovir. CMV resistance testing was completed in two patients with one having a documented mutation and ultimately requiring leflunomide to achieve clearance of viremia. Six patients experienced rejection within one month prior to or during the time of treatment for CMV, no patients lost the allograft due to CMV infection, and no CMV related death occurred in this patient population. Six patients experienced hematologic side effects including leukopenia, neutropenia, and/or thrombocytopenia.

Conclusions: This is the first study to assess the use of oral valganciclovir for the treatment of CMV in pITR. Based on these results, oral valganciclovir may be appropriate for the treatment of CMV. Given the limited number of patients included in this study and the high incidence of hematologic side effects, further investigation is warranted.

CITATION INFORMATION: Henry M., Vacha M., Keck M., Florescu D. Evaluation of the Use of Oral Valganciclovir for the Treatment of Cytomegalovirus Infections in Pediatric Intestinal Transplant Recipients: A Single Center Review Am J Transplant. 2017;17 (suppl 3).

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