Multicenter Analysis of Valganciclovir Prophylaxis in Pediatric Solid Organ Transplant Recipients

Resource type
Journal Article
Authors/contributors
Title
Multicenter Analysis of Valganciclovir Prophylaxis in Pediatric Solid Organ Transplant Recipients
Abstract
Abstract Background Valganciclovir is the only approved antiviral for cytomegalovirus (CMV) prevention in pediatric solid organ transplantation (SOT). Additional approaches may be needed to improve outcomes. Methods A multicenter retrospective study from 2016 to 2019 was conducted of pediatric SOT recipients in whom at least 3 months of valganciclovir prophylaxis was planned. Episodes of CMV DNA in blood (DNAemia), CMV disease, drug-related toxicities, as well as other infections in the first year posttransplant and demographic and clinical data were collected. CMV DNAemia in the first year after prophylaxis or during prophylaxis (breakthrough) was analyzed by multivariate hazard models. Results Among the 749 patients enrolled, 131 (17.5%) had CMV DNAemia at any time in the first year; 85 (11.4%) had breakthrough DNAemia, and 46 (6.1%) had DNAemia after prophylaxis. CMV disease occurred in 30 (4%). In a multivariate model, liver transplantation compared to kidney or heart, intermediate or high risk based on donor/recipient serologies, neutropenia, and valganciclovir dose modifications attributed to toxicity were associated with increased risk of total and/or breakthrough DNAemia. Bacteremia was also associated with increased hazard ratio for CMV DNAemia. In a separate multivariate analysis, rejection occurred more often in those with breakthrough CMV DNAemia (P = .002); liver transplants, specifically, had increased rejection if CMV DNAemia occurred in the first year (P = .004). These associations may be bidirectional as rejection may contribute to infection risk. Conclusions CMV DNAemia in the first year posttransplantation occurs despite valganciclovir prophylaxis and is associated with medication toxicity, bacteremia, and rejection. Pediatric studies of newer antivirals, especially in higher-risk subpopulations, appear to be warranted.
Publication
Open Forum Infectious Diseases
Volume
11
Issue
7
Pages
ofae353
Date
2024-06-28
Language
en
ISSN
2328-8957
Accessed
7/9/24, 8:10 PM
Library Catalog
DOI.org (Crossref)
Citation
Foca, M., Demirhan, S., Munoz, F. M., Valencia Deray, K. G., Bocchini, C. E., Sharma, T. S., Sherman, G., Muller, W. J., Heald-Sargent, T., Danziger-Isakov, L., Blum, S., Boguniewicz, J., Bacon, S., Joseph, T., Smith, J., Ardura, M. I., Su, Y., Maron, G. M., Ferrolino, J., & Herold, B. C. (2024). Multicenter Analysis of Valganciclovir Prophylaxis in Pediatric Solid Organ Transplant Recipients. Open Forum Infectious Diseases, 11(7), ofae353. https://doi.org/10.1093/ofid/ofae353
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