*Purpose: Cytomegalovirus (CMV) disease continues to stand as a significant threat to the longevity of renal transplants in children. More pediatric recipients are CMV negative with CMV positive donor serologies resulting in a high risk (HR) mismatch. The length of prophylaxis with ganciclovir (GCV) or valganciclovir (VGCV) required to optimally prevent recurrence of CMV DNAemia remains unknown.

*Methods: This study is a meta-analysis comparing GCV/VGCV prophylaxis regimens provided for <6 months, from 6 to <12 months, and ≥12 months after transplant in order to prevent CMV DNAemia. The search conducted involved PubMed, EMBASE, ISI Web of Science, and Cochrane Central Register from inception through December 2017. Search terms Kidney Transplantation, CMV, Valganciclovir provided 204 studies for abstract review. Studies excluded were those which did not itemize pediatric data separately, single case reports, and duplicate studies.

*Results: Pooled analysis of 6 retrospective studies identified that there is no statistically significant difference in the incidence of CMV DNAemia when comparing <6 months of prophylaxis and >12 months of prophylaxis (23% and 15%, respectively, p=0.23). Regardless of the length of prophylaxis there was no statistical difference in the incidence of CMV reactivation in the HR patients (6 to <12month vs <6month, p=0.62; 6 to <12month vs ≥12month, p=0.78; ≥12month vs <6months, p=0.83).

*Conclusions: This study identifies no optimal length of prophylaxis for HR mismatch pediatric renal transplant patients because regardless to administration of GCV/VGCV they develop CMV DNAemia. Increasing the regimen beyond 6 months appears to provide limited added benefit while sustaining the risk of side effects.

« Back to 2019 American Transplant Congress