CYTOMEGALOVIRUS-INFECTION AFTER KIDNEY-TR ANSPLANTATION IN PEDIATRIC-PATIENTS

Cytomegalovirus (CMV) infection, the most common complication of kidne y transplantation, has less impact on patient and transplant survival in children than In adults and has become considerably less severe sin ce the introduction of ganciclovir therapy. A retrospective study of 9 15 transplant recipients performed between 1973 and 1994 showed that 1 32 patients developed CMV infection within four months after the proce dure, with moderate symptoms in 85 cases and severe organ damage in 47 . A negative CMV serostatus was associated with a higher prevalence of CMV disease (16%) than a positive CMV serostatus (5%). Routine use of acyclovir therapy in recipients of kidneys from CMV seropositive dono rs started in April 1991 failed to change the prevalence of CMV diseas e but, together with early curative ganciclovir therapy, eliminated al l CMV-related mortality. In the 30 patients given curative ganciclovir therapy, the dosage was adjusted to renal function, mean treatment du ration was 14 days, and tolerance was satisfactory, with 14 cases of h ematologic toxicity (leukopenia, n = 6; thrombocytopenia, n = 8) that responded well to treatment modification. Serum ganciclovir levels wer e monitored in 15 patients, and indicated a need for a dosage modifica tion in 12 (increase, n = 4; decrease, n = 8). A full recovery was ach ieved after the first course in 26 cases and after the second course i n two cases. Two children died after delayed onset of ganciclovir ther apy. Serum CMV antigen detection was introduced in 1992 to ensure earl y diagnosis and therefore early treatment of CMV infection; since this tool has been in use, there have been no deaths. Of the 30 patients w ho received ganciclovir therapy, 21 had a deterioration in renal funct ion, which was due to a rejection episode in seven patients, of whom f ive lost their kidney. However, in this series, actuarial survival rat es for patients and transplants were not affected by the occurrence of CMV infection.