Background: Infection is the leading cause of hospitalization in pediatric renal transplant recipients. The impact of specific immunosuppressive agents on the incidence of infectious complications posttransplant is an area of controversy. We performed a retrospective study comparing the association of induction therapy with IL-2RA daclizumab versus thymoglobulin, on the incidence of subclinical viremia due to CMV, EBV, and BKV in our cohort of pediatric renal transplant recipients.

Methods: We assessed CMV, EBV, and BKV plasma DNAemia by monthly real-time PCR in pediatric renal transplant recipients for the first 1 year posttransplant. Subclinical viremia was defined as asymptomatic DNAemia. Only unsensitized recipients of first kidney transplants were included. Patients in the IL-2RA cohort received daclizumab induction with tacrolimus and MMF. In 2010, our standard immunosuppression protocol changed to thymoglobulin induction with tacrolimus and MMF.

Results: A total of 82 first kidney alone recipients were included; 38 received daclizumab and 44 received thymoglobulin induction. Comparing the 2 groups, there was no difference in recipient demographics, donor source, or donor/recipient serostatus of CMV and EBV. Subclinical CMV infection occurred in 22% of the IL-2RA group and 27% of the thymoglobulin group (p=0.8). Subclinical EBV infection occurred in 26% of the IL-2RA group and 25% of the thymoglobulin group (p=0.9). BK viremia occurred in 13% of the IL-2RA group compared to 32% of the thymoglobulin group (p=0.05). There was no significant difference in the number of cases of BKVAN.

Conclusion: Comparing induction with IL-2RA versus thymoglobulin in pediatric renal transplant recipients, there was no difference in the incidence of subclinical CMV or EBV viremia in the first post-transplant year. BK viremia occurred more frequently in the thymoglobulin group but there was no increase in BK virus associated nephropathy.

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