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Updated: Feb 9, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Cytomegalovirus infection in the first year after pediatric kidney transplantation
Corentin Tanné1, Pascal Roy2, Émilie Frobert3
1Centre de référence des maladies rénales rares, service de néphrologie, rhumatologie dermatologie pédiatriques, hospices civils de Lyon, 69003 Lyon, France; Université Claude-Bernard Lyon 1, 69000 Lyon, France.
Insights
Cytomegalovirus (CMV) infection affects 27.9% of pediatric kidney transplant recipients within the first year. Donor/recipient CMV status significantly influences infection risk, underscoring the need for vigilant monitoring, especially in intermediate-risk patients.
Area of Science:
- Pediatric Nephrology
- Transplant Immunology
- Virology
Background:
- Cytomegalovirus (CMV) is prevalent in adult transplant recipients (40-90%).
- Pediatric kidney transplant recipients are susceptible to primary CMV infection or reactivation due to immunosuppression.
- The incidence of CMV infection in this population remains understudied.
Purpose of the Study:
- To determine the incidence and timing of CMV infection in the first year post-kidney transplantation in children.
- To analyze CMV infection rates based on donor (D) and recipient (R) CMV serostatus (high-risk D+/R-, intermediate-risk R+, low-risk D-/R-).
Main Methods:
- Retrospective cohort study of 136 pediatric kidney transplant recipients (2003-2014).
- Patients categorized into high, intermediate, and low CMV risk groups based on serostatus.
- CMV infection defined as asymptomatic viral replication; CMV disease as symptomatic replication.
- Oral valganciclovir prophylaxis administered to high-risk recipients.
Main Results:
- Overall, 38 patients (27.9%) developed CMV infection within the first year.
- Incidence was highest in high-risk (40.6%) and intermediate-risk (45.3%) groups.
- Ten infected patients developed tissue-invasive CMV disease.
Conclusions:
- CMV infection occurs in 27.9% of pediatric kidney transplant recipients during the first year.
- Donor and recipient CMV serostatus are critical determinants of infection risk.
- Enhanced surveillance is crucial for intermediate-risk patients to prevent severe outcomes.
Abstract:
Cytomegalovirus is common in adult recipients (prevalence of 40-90%). Children are typically seronegative but immunosuppression may prone to primary-infection or viral reactivation, with potentially severe consequences. CMV infection incidence in pediatric kidney transplant recipients has seldom been investigated. The aim of our study was to evaluate the incidence and timing of CMV infection during the first year after renal transplantation. We assembled a retrospective cohort of 136 children who had received a kidney transplant between 2003 and 2014 with a year follow-up. The patients were classified regarding CMV infection as high risk (D+/R-), intermediate risk (R+) or low risk (D-/R-). CMV infection was defined by the viral replication remaining asymptomatic whereas CMV disease concerned viral replication with clinical and/or biological symptoms. Oral valganciclovir was used as prophylaxis for high-risk recipients. A total of 38 patients (27.9%) developed CMV infection, 13 (40.6%) of the 32 D+/R-, 24 (45.3%) of the 53 R+ and 1 (2.0%) of the 51 D-/R-. Of these 38 infected patients, 10 developed tissue-invasive disease. During the first year after kidney transplantation, 27.9% of recipients developed CMV infection. This study confirms the influence of donor and recipient CMV status on infection propensity and highlights the importance of adequate follow-up for intermediate risk patients.
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