Cytomegalovirus Infection in Pediatric Renal Transplant Recipients: A Single Center Experience
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Purpose: To investigate the frequency, presentation, management, and outcome of cytomegalovirus (CMV) infection in pediatric patients who underwent renal transplantation. Methods: We performed a retrospective chart review of 70 patients under the age of 18, who underwent renal transplantation between January 1990 and November 2014. A diagnosis of CMV infection was based on serology, molecular assays, antigenemia assays, and culture. CMV infection was defined as detection of virus and CMV disease was diagnosed when clinical signs and symptoms were present. Results: The number of patients with CMV infection was 18 (25.7% of renal transplant recipients). Twelve were male (66.7%), and the mean±standard deviation (SD) age at infection was 13.3±3.9 years. Median time of infection after renal transplantation was 4 months (range 1.0-31.0 months). Pretransplantation CMV status in the infected group was as follows: donor (D)+/recipient (R)+, 11 (61.1%); D+/R-, 7 (38.9%); D-/R+, 0; and D-/R- 0. Nine patients had CMV disease with fever, leukopenia, thrombocytopenia, or organ involvement such as enteritis, hepatitis, and pneumonitis. The age of disease occurrence was 13.1±3.9 years and the median time to disease onset after renal transplantation was 8 months (range 1.0-31.0). Immunosuppressive agents were reduced or discontinued in 14 patients (77.8%), antiviral agents were used in 11 patients (61.1%), and all patients with CMV infection were controlled. Conclusions: A quarter of the patients had CMV infection about 4 months after renal transplantation. CMV infection was successfully treated with reduction of immunosuppressants or with antiviral agents.
Abstract
Purpose: To investigate the frequency, presentation, management, and outcome of cytomegalovirus (CMV) infection in pediatric patients who underwent renal transplantation. Methods: We performed a retrospective chart review of 70 patients under the age of 18, who underwent renal transplantation between January 1990 and November 2014. A diagnosis of CMV infection was based on serology, molecular assays, antigenemia assays, and culture. CMV infection was defined as detection of virus and CMV disease was diagnosed when clinical signs and symptoms were present. Results: The number of patients with CMV infection was 18 (25.7% of renal transplant recipients). Twelve were male (66.7%), and the mean±standard deviation (SD) age at infection was 13.3±3.9 years. Median time of infection after renal transplantation was 4 months (range 1.0-31.0 months). Pretransplantation CMV status in the infected group was as follows: donor (D)+/recipient (R)+, 11 (61.1%); D+/R-, 7 (38.9%); D-/R+, 0; and D-/R- 0. Nine patients had CMV disease with fever, leukopenia, thrombocytopenia, or organ involvement such as enteritis, hepatitis, and pneumonitis. The age of disease occurrence was 13.1±3.9 years and the median time to disease onset after renal transplantation was 8 months (range 1.0-31.0). Immunosuppressive agents were reduced or discontinued in 14 patients (77.8%), antiviral agents were used in 11 patients (61.1%), and all patients with CMV infection were controlled. Conclusions: A quarter of the patients had CMV infection about 4 months after renal transplantation. CMV infection was successfully treated with reduction of immunosuppressants or with antiviral agents.
참고문헌 (20)
- Einollahi B, "Cytomegalovirus infection following kidney transplantation: A multicenter study of 3065 cases", International journal of organ transplantation medicine, 3, pp.74~ (2012)
- Sagedal S, "A prospective study of the natural course of cytomegalovirus infection and disease in renal allograft recipients", Transplantation, 70, pp.1166~1174 (2000)
- Razonable RR, "Cytomegalovirus in solid organ transplantation", Am J Transplant, 13(Suppl 4), pp.93~106 (2013)
- Ljungman P, "Definitions of cytomegalovirus infection and disease in transplant recipients", Clin Infect Dis, 34, pp.1094~1097 (2002)
- Fijo-Lopez-Viota J, "Cytomegalovirus and paediatric renal transplants: is this a current issue?", Nefrologia, 33, pp.7~13 (2013)
- Cordero E, "Cytomegalovirus disease in kidney transplant recipients: incidence, clinical profile, and risk factors", Transplant Proc, 44, pp.694~700 (2012)
- Giakoustidis D, "Prevalence and clinical impact of cytomegalovirus infection and disease in renal transplantation: ten years of experience in a single center", Transplantation proceedings, pp.2715~2717 (2012), Elsevier
- Carstens J, "Cytomegalovirus infection in renal transplant recipients", Transpl Infect Dis, 8, pp.203~212 (2006)
- Kranz B, "Acute rejection episodes in pediatric renal transplant recipients with cytomegalovirus infection", Pediatr Transplant, 12, pp.474~478 (2008)
- Camacho-Gonzalez AF, "24 weeks of valganciclovir prophylaxis in children after renal transplantation: a 4-year experience", Transplantation, 91, pp.245~250 (2011)
- 서세영, "학령 전기 소아에서 거대세포바이러스IgG 항체 양성률의 변동", Korean Journal of Pediatrics, 49(1), pp.51~55 (2006), 대한소아과학회
- Ho M, "Epidemiology of cytomegalovirus infections", Rev Infect Dis, 12(Suppl 7), pp.S701~S710 (1990)
- Bhadauria D, "Cytomegalovirus disease in renal transplant recipients: a single-center experience", Indian J Microbiol, 52, pp.510~515 (2012)
- Taherimahmoudi M, "Cytomegalovirus infection and disease following renal transplantation: preliminary report of incidence and potential risk factors", Transplant Proc, 41, pp.2841~2844 (2009)
- Lebranchu Y, "Immunoprophylaxis with basiliximab compared with antithymocyte globulin in renal transplant patients receiving MMF-containing triple therapy", Am J Transplant, 2, pp.48~56 (2002)
- Sia IG, "New strategies for prevention and therapy of cytomegalovirus infection and disease in solid-organ transplant recipients", Clin Microbiol Rev, 13, pp.83~121 (2000)
- Corona-Nakamura AL, "Incidence and predictive factors for cytomegalovirus infection in renal transplant recipients", Transplant Proc, 41, pp.2412~2415 (2009)
- Winston DJ, "Randomized controlled trial of oral ganciclovir versus oral acyclovir after induction with intravenous ganciclovir for long-term prophylaxis of cytomegalovirus disease in cytomegalovirus-seropositive liver transplant recipients", Transplantation, 75, pp.229~233 (2003)
- Luan FL, "Six-month prophylaxis is cost effective in transplant patients at high risk for cytomegalovirus infection", J Am Soc Nephrol, 20, pp.2449~2458 (2009)
- Humar A, "The efficacy and safety of 200 days valganciclovir cytomegalovirus prophylaxis in high-risk kidney transplant recipients", Am J Transplant, 10, pp.1228~1237 (2010)