24 Weeks of Valganciclovir Prophylaxis in Children After Renal Transplantation: A 4-Year Experience

• Type of Material: Article
• Authors: Andres Camacho-Gonzalez, Emory University; Julie R. Gutman, Emory University; Leonard C Hymes, Emory University; Traci Leong, Emory University; Joseph Hilinski, Emory University
• Language: English
• Date: 2011-01-27
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2011 by Lippincott Williams & Wilkins
• Final Published Version (URL): http://journals.lww.com/transplantjournal/Abstract/2011/01270/24_Weeks_of_Valganciclovir_Prophylaxis_in_Children.18.aspx
• Title of Journal or Parent Work: Transplantation
• ISSN: 0041-1337
• Volume: 91
• Issue: 2
• Start Page: 245
• End Page: 250
• Grant/Funding Information: This work was supported in part by PHS Grant UL1 RR025008 and KL2 rR025009 from the Clinical and Translational Science Award program, National Institutes of Health, and National Center for Research Resources (J.G.); research support from Bristol-Myers Squibb (A.F.C.-G.); and research support from Pfizer pharmaceutical (J.A.H.).
• Keywords: Valganciclovir; Children; CMV
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background Cytomegalovirus (CMV) is the most common opportunistic infection after solid-organ transplant. Valganciclovir prophylaxis significantly reduces disease, but limited data are available on its use in children. Recently, an increase in delayed-onset CMV disease has been noted with some arguing that longer prophylaxis may decrease late-onset disease. Methods Single-center, retrospective analysis of pediatric renal transplant patients receiving 24 weeks valganciclovir prophylaxis (15 mg/kg/day, maximum 900 mg/day) from January 2004 to December 2008, aiming to measure the incidence of CMV disease and toxicity of valganciclovir. Results We enrolled 111 patients, 60% males, 46% African Americans, and median age at transplant 14.5 years (range 1.4–20.4 years). Sixty-nine percent of donors and 44% of recipients were seropositive pretransplant. Median duration of valganciclovir use was 5.9 months (range 0.5–24 months). CMV viremia and disease occurred in 27% and 4.5%, respectively. All patients with disease presented after prophylaxis ended and all were D+/R−. Thymoglobulin use (P=0.04) and positive donor CMV status (P=0.02) were associated with a higher risk of CMV viremia. Twenty-four percent had hematologic toxicity directly associated with valganciclovir. Conclusions Valganciclovir use in children was effective as prophylaxis against CMV disease; no children at our institution developed disease while on therapy. Our regimen of 24 weeks of prophylaxis was associated with a lower rate of late-onset disease than previous reports with 12-week regimens. Further controlled studies should be considered to compare longer versus shorter periods of prophylaxis and dose reductions and their impact on prevention of late-onset disease, resistance, cost, and toxicity.