Cytomegalovirus infection after kidney transplantation in pediatric patients.

Cytomegalovirus (CMV) infection, the most common complication of kidney transplantation, has less impact on patient and transplant survival in children than In adults and has become considerably less severe since the introduction of ganciclovir therapy. A retrospective study of 915 transplant recipients performed between 1973 and 1994 showed that 132 patients developed CMV infection within four months after the procedure, 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 donors started in April 1991 failed to change the prevalence of CMV disease but, together with early curative ganciclovir therapy, eliminated all CMV-related mortality. In the 30 patients given curative ganciclovir therapy, the dosage was adjusted to renal function, mean treatment duration was 14 days, and tolerance was satisfactory, with 14 cases of hematologic toxicity (leukopenia, n = 6; thrombocytopenia, n = 8) that responded well to treatment modification. Serum ganciclovir levels were monitored in 15 patients, and indicated a need for a dosage modification in 12 (increase, n = 4; decrease, n = 8). A full recovery was achieved after the first course in 26 cases and after the second course in two cases. Two children died after delayed onset of ganciclovir therapy. Serum CMV antigen detection was introduced in 1992 to ensure early diagnosis and therefore early treatment of CMV infection; since this tool has been in use, there have been no deaths. Of the 30 patients who received ganciclovir therapy, 21 had a deterioration in renal function, which was due to a rejection episode in seven patients, of whom five lost their kidney. However, in this series, actuarial survival rates for patients and transplants were not affected by the occurrence of CMV infection.