Joint first authors.
Subclinical cytomegalovirus and Epstein–Barr virus viremia are associated with adverse outcomes in pediatric renal transplantation
Article first published online: 27 NOV 2006
Volume 11, Issue 2, pages 187–195, March 2007
How to Cite
Li, L., Chaudhuri, A., Weintraub, L. A., Hsieh, F., Shah, S., Alexander, S., Salvatierra, O. and Sarwal, M. M. (2007), Subclinical cytomegalovirus and Epstein–Barr virus viremia are associated with adverse outcomes in pediatric renal transplantation. Pediatric Transplantation, 11: 187–195. doi: 10.1111/j.1399-3046.2006.00641.x
- Issue published online: 27 NOV 2006
- Article first published online: 27 NOV 2006
- Accepted for publication 29 September 2006
- pediatric renal transplant;
- cytomegalovirus and Epstein–Barr virus viremia;
- steroid-free immunosuppression;
- antiviral prophylaxis;
- acute rejection
Abstract: Post-transplant clinical disease with cytomegalovirus (CMV) and Epstein–Barr virus (EBV) is a known risk factor for graft dysfunction and lymphoproliferation. We postulate that subclinical, asymptomatic viremia also adversely impacts outcomes, and may warrant re-assessment of current monitoring and antiviral prophylaxis protocols. A single-center study was conducted on 102 pediatric (51 steroid-free and 51 matched steroid-based historical controls). Quantitative viral loads were serially monitored and correlated with outcome measures. Overall, the incidence of CMV and EBV clinical disease was 5% (1% CMV and 4% EBV); however, the incidence of subclinical viremia was 44% (12.7% CMV, 38.2% EBV, 6.9% CMV + EBV). Risk factors for subclinical viremia were EBV naivety (p = 0.07), age less than five yr (p = 0.04), lack of prophylaxis (p = 0.01), and steroid usage (p = 0.0007). Subclinical viremia was associated with lower three-yr graft function (p = 0.03), increased risk of acute rejection (odds ratio 2.07; p = 0.025), hypertension (p = 0.04), and graft loss (p = 0.03). Subclinical asymptomatic CMV and EBV viremia is a risk factor for graft injury and loss. These findings support the need for aggressive, serial viral monitoring to better determine the appropriate length of post-transplant antiviral prophylaxis, and to determine the effect of immunosuppression protocols on the development of viremia.