Cytomegalovirus prophylaxis after kidney transplantation in children: Longer is better

Abstract

Introduction CMV infection is the second most frequent opportunistic infection following kidney transplantation. Moreover, CMV infection and CMV disease are known as independent risk factors for acute rejection, and CMV viremia can lead to chronic allograft injury and subsequent graft failure. Conducted in 2010, the IMPACT study showed that extending valganciclovir prophylaxis from 100 to 200 days significantly decreased CMV disease in adult kidney transplant recipients. However, CMV prophylaxis has never been specifically codified in paediatric kidney transplant recipients. Methods This monocentric retrospective cohort study compared the efficacy and safety of 100-days versus 200-days CMV prophylaxis in 64 paediatric kidney transplant recipients between 2005 and 2015, at one-year post-transplantation. Main outcomes included CMV disease and infection, rejection, eGFR, graft loss and treatment tolerance. Results CMV infection or disease were significantly lower in the 200-days group (23% versus 52%, P = 0.026 at one year). There was no significant difference in the GFR between groups. Treatment was well tolerated (12% of prophylaxis stopped, side effects were reversible). Longer prophylaxis was not associated with an increase of adverse effects. The 100-day prophylaxis and living donor were the only significant risk factors found in multiple variable analysis (respectively OR = 9.1, 95% CI 1.61–58.5 and OR = 14.89, 95% CI 2.04–108.46). Conclusion The 200-day compared to 100-day prophylaxis safely reduces CMV infection or disease at one year post-transplantation in paediatric kidney transplant recipients. Living donor was the highest independent risk factor in multiple variable analysis. These results also suggest that a longer prophylaxis, if well tolerated, could decrease CMV infection and CMV disease even further in paediatric kidney transplant recipients.