*Purpose: Epstein-Barr virus (EBV) infection after pediatric kidney transplant (pKTx) is common and can lead to post transplant lymphoproliferative disorder (PTLD). Valganciclovir (VGN) is used to prevent cytomegalovirus (CMV) infection after pKTx and has invitro activity against EBV. The aim of this study is to determine if VGN PPX delays or prevents EBV viremia after pKTx.

*Methods: Retrospective review of pKTx patients at Primary Children’s Hospital from 1/2015-12/2019. Patients received VGN PPX for 100 days post-KTx if they were moderate or high risk for CMV. Immunosupression (IS) was standardized across all patients (tacrolimus + mycophenolate), 1 patient was excluded due to large modifications in IS. The primary endpoint was time to detectable EBV viremia within the first-year post-KTx. Secondary endpoints included incidence of EBV viremia stratified by serologic risk, incidence of PTLD, incidence of biopsy proven rejection, and incidence of CMV/EBV coinfection within one-year KTx.

*Results: A total of 72 patients were included (Table 1, EBV low risk patients not shown). Only EBV high risk patients developed EBV viremia within the study period. Median time to EBV viremia was 73 days with no VGN PPX, and 154 days for patients receiving VGN PPX (p=0.69). Incidence of EBV viremia within one-year was 11/20 (55%) for the PPX group and and 6/11 (54.5%) for no PPX group (p=1). Two patients with EBV viremia developed subsequent PTLD. CMV/EBV co-infection developed in 5/20 patients (25%) that received PPX and 1/11 (9%) that did not receive PPX (p=0.38). No rejection or graft loss occurred within 1 year.

*Conclusions: VGN PPX may delay, but not prevent, EBV viremia for pKTx recipients who are high risk for infection. Larger multi-centered data are needed to determine if this delay could lead to reduction in EBV associated PTLD.

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