Valganciclovir: therapeutic role in pediatric solid organ transplant recipients

Introduction: Cytomegalovirus (CMV) infection is a common infectious complication after solid organ transplantation (SOT) and is associated with the increased risk of opportunistic infections and allograft rejection, as well as decreased patient survival. Ganciclovir has been the mainstay antiviral agent for prevention and treatment of CMV; however, its clinical use is hampered by the poor oral bioavailability and the need for intravenous access. Valganciclovir, an oral prodrug of ganciclovir, is up to 10 times more bioavailable than oral ganciclovir and has replaced ganciclovir as a first-line agent in the management of CMV in adult SOT patients. Areas covered: This article examines the safety and efficacy of valganciclovir in pediatric SOT patients, with a particular focus on prophylaxis of CMV infections. An in-depth review of the literature, including pertinent data from the adult SOT population, and a discussion of unmet needs are provided. The pharmacokinetics and pharmacodynamics of valganciclovir in the pediatric population are also discussed. Expert opinion: Existing evidence supports the use of valganciclovir in pediatric SOT patients for CMV prophylaxis. Although comprehensive data are lacking, valganciclovir is a treatment option for CMV infection in pediatric SOT patients. The role of valganciclovir in pediatrics is expected to grow given its demonstrated efficacy in a variety of clinical settings and its advantages over ganciclovir.