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Valganciclovir prophylaxis for cytomegalovirus infection in pediatric kidney transplant recipients: a single-center experience

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Abstract

Background

There are two approaches for treating cytomegalovirus (CMV) infection occurring after kidney transplantation (KTx). One is preemptive therapy in which treatment is started after confirming positive CMV antigenemia using periodic antigenemia assay. The other approach is prophylactic therapy in which oral valganciclovir (VGCV) is started within 10 days after KTx and continued for 200 days. The Transplantation Society guidelines recommend prophylactic therapy for high-risk (donor’s CMV-IgG antibody positive and recipient’s negative) pediatric recipients. However, the adequate dose and side effects of VGCV are not clear in children, and there is no sufficient information about prophylaxis for Japanese pediatric recipients.

Methods

A single-center retrospective analysis was conducted on case series of high-risk pediatric patients who underwent KTx and received oral VGCV prophylaxis at the Department of Pediatric Nephrology, Tokyo Women’s Medical University, between August 2018 and March 2019. Data were collected using medical records.

Results

The dose of administration was 450 mg in all the study patients (n = 5). Reduction or discontinuation was required in four of five patients due to adverse events, which included neutropenia in one patient, anemia in two patients, and neutropenia and digestive symptoms in one patient. Late-onset CMV disease occurred in all patients. No seroconversion was observed during prophylaxis.

Conclusions

Our preliminary study suggests that the dosage endorsed by The Transplantation Society may be an overdose for Japanese pediatric recipients. Further studies are required to examine the safety and efficacy of VGCV prophylaxis in Japanese pediatric recipients.

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Acknowledgments

We would like to express our sincere appreciation to all related parties and staff at the Department of Pediatric Nephrology of TWMU who cooperated in this study and MARUZEN-YUSHODO Co., Ltd. (https://kw.maruzen.co.jp/kousei-honyaku/) for the English language editing.

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Authors and Affiliations

  1. Department of Pediatric Nephrology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Takaya Iida, Kenichiro Miura, Hideki Ban, Taro Ando, Yoko Shirai, Sho Ishiwa, Atsutoshi Shiratori, Naoto Kaneko, Tomoo Yabuuchi, Kiyonobu Ishizuka & Motoshi Hattori

  2. Department of Pediatrics, Matsuyama Red Cross Hospital, Ehime, Japan

    Masanori Takaiwa

  3. Department of Pediatrics, Fukushima Medical University, Fukushima, Japan

    Kazuhide Suyama

  4. Department of Nephrology, Chiba Children’s Hospital, Chiba, Japan

    Masataka Hisano

Authors
  1. Takaya Iida
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  2. Kenichiro Miura
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  3. Hideki Ban
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  4. Taro Ando
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  5. Yoko Shirai
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  11. Masanori Takaiwa
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  12. Kazuhide Suyama
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  13. Masataka Hisano
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  14. Motoshi Hattori
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Contributions

TI designed the study and wrote the initial draft of the manuscript. KM and HB contributed to analysis and interpretation of data and assisted in the preparation of the manuscript. TA, YS, SI, AS, NK, TY, KI, MT, KS, and MH contributed to data collection and critically reviewed the manuscript. MH supervised the findings of this work. All authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Motoshi Hattori.

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Conflict of interest

The authors have no conflict of interest to declare.

Ethical approval

This study was conducted in accordance with the ethical principles set out in the Declaration of Helsinki and the ethical guidelines for epidemiological studies issued by the Ministry of Health, Labour and Welfare, Japan. The Ethics Committee of the TWMU approved the study (approval no. 5528).

Informed consent

Informed consent was waived by giving the patients' parents an opportunity to opt out.

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Cite this article

Iida, T., Miura, K., Ban, H. et al. Valganciclovir prophylaxis for cytomegalovirus infection in pediatric kidney transplant recipients: a single-center experience. Clin Exp Nephrol 25, 531–536 (2021). https://doi.org/10.1007/s10157-021-02020-z

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  • DOI: https://doi.org/10.1007/s10157-021-02020-z

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