Premium
Impact of standardized protocols for cytomegalovirus disease prevention in pediatric solid organ transplant recipients
Author(s) -
Ganapathi Lakshmi,
Blumenthal Jennifer,
Alawdah Laila,
Lewis Lynne,
Gilarde Jennifer,
Jones Sarah,
Milliren Carly,
Kim Heung Bae,
Sharma Tanvi S.
Publication year - 2019
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13568
Subject(s) - medicine , valganciclovir , asymptomatic , neutropenia , pediatrics , cytomegalovirus , population , intensive care medicine , retrospective cohort study , disease , ganciclovir , human cytomegalovirus , viral disease , chemotherapy , human immunodeficiency virus (hiv) , immunology , virus , herpesviridae , environmental health
End‐organ disease caused by CMV is a significant cause of morbidity and mortality in pediatric SOT recipients. Pediatric transplant centers have adopted various approaches for CMV disease prevention in this patient population. We observed significant practice variation in CMV testing, prophylaxis, and surveillance across SOT groups in our center. To address this, we implemented evidence‐based standardized protocols and measured outcomes pre‐ and post‐implementation of these protocols. We performed retrospective chart review for SOT recipients from 2009 to 2014 at Boston Children's Hospital. Using descriptive statistics, we measured practice improvement in provision of appropriate prophylaxis, occurrence of neutropenia and associated complications, and occurrence of CMV DNAemia and CMV disease pre‐ and post‐intervention. The pre‐ and post‐intervention periods included 141 and 109 patients, respectively. With the exception of kidney transplant recipients, provision of appropriate valganciclovir prophylaxis improved across SOT groups post‐intervention ( P < .01). Occurrence of >1 episode of neutropenia was greater in the preintervention period (30% vs 10%, P < .001). In both periods, neutropenia was associated with few episodes of invasive infections. The occurrence of CMV disease did not differ and was overall low. However, due to routine surveillance a significantly greater number of asymptomatic CMV DNAemia episodes were identified and treated in the post‐intervention period. Implementation of standardized prevention protocols helped to improve the provision of appropriate prophylaxis to patients at risk for CMV acquisition, increased the diagnosis and treatment of asymptomatic CMV DNAemia, and decreased episodes of recurrent neutropenia in patients receiving prophylaxis.