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Published on: May 25, 2019
Prospective, comprehensive, and effective viral monitoring in Cuban children undergoing solid organ transplantation
Vivian Kourí1, Consuelo Correa2, Pedro A Martínez2
1Sexually Transmitted Diseases Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba ; Virology Department, Institute of Tropical Medicine ¨Pedro Kourí¨, Autopista Novia del Mediodia Km 6., La Lisa, Havana City, Cuba.
Insights
Routine viral monitoring in Cuban pediatric transplant patients identified cytomegalovirus (CMV) and BK virus (BKV) as most frequent. This program effectively prevents critical viral disease, recommending qRT-PCR for all Cuban organ recipients.
Area of Science:
- Virology
- Transplant Medicine
- Pediatric Infectious Diseases
Background:
- Viral infections pose significant risks in pediatric solid organ transplant (SOT) recipients.
- Routine viral monitoring was not standard practice in post-transplant Cuban children.
- Implementing proactive viral surveillance is crucial for managing post-transplant complications.
Purpose of the Study:
- To identify prevalent viruses affecting transplanted Cuban children.
- To establish a viral follow-up protocol in the post-transplant period.
- To assess the efficacy of quantitative real-time polymerase chain reaction (qRT-PCR) for viral detection.
Main Methods:
- Prospective monitoring of 34 pediatric SOT recipients (kidney and liver) over 34 weeks.
- Simultaneous detection of multiple viral DNA in plasma and urine using qRT-PCR.
- Targeted viruses included CMV, EBV, HSV-1/2, VZV, HHV-6, AdV, BKV, and JCV.
Main Results:
- Viral genomes detected in 21 of 34 recipients; 18 had viral DNA in urine, 12 had DNAemia.
- Cytomegalovirus (CMV) at 41.2% and BK virus (BKV) at 35.3% were the most frequent.
- CMV viruria predicted CMV viremia (OR: 8.4), with CMV linked to symptoms and DNAemia.
Conclusions:
- Comprehensive viral monitoring effectively prevents critical post-transplant viral diseases.
- Quantitative real-time PCR (qRT-PCR) is recommended for routine viral surveillance in Cuban organ recipients.
- Early detection and preemptive treatment (e.g., ganciclovir) mitigate clinical complications.
Purpose:
In Cuba, viral monitoring in the post-transplant period was not routinely performed. The aim of this research is to identify the most frequent viruses that affect transplanted Cuban children, by implementing a viral follow-up during the post-transplant period.
Methods:
The study population included all Cuban pediatric patients who underwent solid organ transplantation (SOT) between November 2009 and December 2012. A total of 34 transplanted pediatric patients of kidney (n = 11) and liver (n = 23) were prospectively monitored during a 34-week period for viral DNAemia and DNAuria by simultaneous detection of cytomegalovirus (CMV), Epstein-Barr virus, herpes simplex virus type 1 and 2, varicella zoster virus, human herpesvirus 6, human adenovirus, and polyomaviruses (BKV and JCV) using quantitative real-time polymerase chain reaction (qRT-PCR).
Results:
Viral genome of at least one virus was detected in 21 of 34 recipients, 18 patients excreted virus in urine while 12 presented DNAemia. CMV (41.2%) and BKV (35.3%) were the most frequent viruses detected during the follow-up. CMV was the virus mainly associated with clinical symptoms and DNAemia. Its excretion in urine (with cut off value of 219 copies/mL) was associated with detection in plasma (p < 0.001); furthermore, CMV viruria was predictive of CMV viremia (OR:8.4, CI:2.4-29.1, p = 0.001). There was no association between high viral load and clinical complications, due to the prompt initiation of preemptive ganciclovir.
Conclusion:
This comprehensive viral monitoring program effectively prevents the development of critical viral disease, thus urge the implementation of qRT-PCR as routine for viral monitoring of transplanted Cuban organ recipients.