Cytomegalovirus Infection in Pediatric Renal Transplantation and the Impact of Chemoprophylaxis With (Val-)Ganciclovir

Transplantation. 2016 Apr;100(4):862-70. doi: 10.1097/TP.0000000000000888.


Background: Cytomegalovirus (CMV) replication and disease, with its associated morbidity and poor transplant outcome, represents a serious threat to transplant recipients. The pediatric kidney transplant population is at a particularly increased risk of CMV infection.

Methods: We therefore analyzed CMV epidemiology in a large cohort of pediatric renal transplant recipients (n = 242) and assessed the impact of antiviral chemoprophylaxis with valganciclovir (VGCV) or ganciclovir (GCV) on CMV replication and morbidity.

Results: While antiviral chemoprophylaxis with VGCV or GCV in patients with a high (D+/R-) or intermediate (D+/R+) CMV risk (n = 82) compared to preemptive therapy (n = 47) had no significant effect on the incidence of CMV syndrome or tissue-invasive disease, chemoprophylaxis was associated with a better preservation of transplant function at 3 years posttransplant (loss of estimated glomerular filtration rate in the chemoprophylaxis cohort, 16.0 ± 3.4 vs. 30.1 ± 4.7 mL/min per 1.73 m(2) in the preemptive therapy cohort, P < 0.05).CMV replication was associated with a more pronounced decline of graft function (difference in estimated glomerular filtration rate of 9.6 mL/min per 1.73 m(2) at 3 years) compared to patients without CMV replication. However, patients undergoing VGCV or GCV chemoprophylaxis had more leukocytopenia.

Conclusion: Antiviral chemoprophylaxis with VGCV or GCV in recipients with a high or moderate CMV risk is associated with a better preservation of transplant function. Hence, the prevention of CMV replication in this patient population has the potential to improve transplant outcome.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Age Factors
  • Antiviral Agents / administration & dosage*
  • Antiviral Agents / adverse effects
  • Child
  • Child, Preschool
  • Cytomegalovirus / drug effects*
  • Cytomegalovirus / pathogenicity
  • Cytomegalovirus Infections / epidemiology
  • Cytomegalovirus Infections / immunology
  • Cytomegalovirus Infections / prevention & control*
  • Cytomegalovirus Infections / virology
  • Drug Administration Schedule
  • Europe / epidemiology
  • Female
  • Ganciclovir / administration & dosage
  • Ganciclovir / adverse effects
  • Ganciclovir / analogs & derivatives*
  • Graft Survival / drug effects
  • Humans
  • Immunocompromised Host
  • Immunosuppressive Agents / adverse effects
  • Incidence
  • Kidney Transplantation* / adverse effects
  • Male
  • Opportunistic Infections / epidemiology
  • Opportunistic Infections / immunology
  • Opportunistic Infections / prevention & control*
  • Opportunistic Infections / virology
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Valganciclovir


  • Antiviral Agents
  • Immunosuppressive Agents
  • Valganciclovir
  • Ganciclovir