Efficacy of Extended Valganciclovir Prophylaxis in Preventing Cytomegalovirus Infection in Pediatric Kidney Transplantation

Cytomegalovirus (CMV) is one of the most frequent opportunistic infection in renal transplant (RTx)recipients. Valganciclovir (VGC) has been showed to be safe and highly effective in prophylaxis of CMV infection inRTx recipients. Recently, an increase in delayed onset CMV disease has been noted with some arguing that longerprophylaxis may decrease the late-onset disease. We retrospectively tested the hypothesis that extended term prophylaxis (ETP) of VGC for 12 months is more effectivethan short term prophylaxis (STP) of 6 months in preventing CMV infection and disease in pediatric RTx performed at theUniversity of Florida from July 2003 to December 2010. In this period, all recipients underwent prospective CMV PCR(Polymerase Chain Reaction) monitoring and were maintained on similar immunosuppression. Eighty six patients received RTx during that period. All eligible subjects had to have at least 12 months of graft survival and18 months of follow up, leaving 73 eligible subjects in final study group. CMV infection or disease occurred in 6/29 (20%) inthe STP group vs 6/44 (14%) in the ETP group with no statistical significant difference (P= 0.42). Donor positive/recipientsnegative CMV serology status (D+/R-) were associated with a higher risk of CMV infection in both univariate andmultivariate analysis (P=0.01). Anemia and Leucopenia directly associated with VGC were similar in both groups (P=0.58and P=0.2 respectively). Biopsy-proven acute rejection was also non-significant in both groups (P=0.39). Although ETP for CMV from 6 months to 12 months is safe and has minimal adverse effect, it did not reduce CMVinfection or disease. Further controlled studies in pediatrics age group are considered to compare longer versus shorterperiods of prophylaxis and their impact on prevention of CMV infection, resistance, cost, and toxicity.