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Generation of Multivirus-specific T Cells to Prevent/treat Viral Infections after Allogeneic Hematopoietic Stem Cell Transplant
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CMV infection and management among pediatric solid organ transplant recipients

Kevin J Downes1,2,3, Anna Sharova2, Craig L K Boge2

  • 1Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

Pediatric Transplantation
|January 7, 2022
PubMed

Insights

Cytomegalovirus (CMV) disease, not just DNAemia, significantly impacts pediatric solid organ transplant outcomes. Focusing prevention on CMV disease is crucial for better patient results.

Area of Science:

  • Transplant medicine
  • Virology
  • Immunology

Background:

  • Cytomegalovirus (CMV) is a significant threat to pediatric solid organ transplant (SOT) recipients, causing morbidity and mortality.
  • The clinical impact of asymptomatic CMV infections, specifically CMV DNAemia, remains unclear in this vulnerable population.

Purpose of the Study:

  • To investigate the association between CMV DNAemia and CMV disease with negative clinical outcomes in pediatric SOT recipients.
  • To evaluate the effectiveness of CMV prophylaxis strategies.

Main Methods:

  • Retrospective cohort study of 271 children undergoing first SOT (January 2012 to June 2018).
  • Multivariable Cox regression analysis to assess the impact of CMV DNAemia and CMV disease on outcomes like death, re-transplantation, and rejection.
  • Evaluation of CMV infection epidemiology and prophylaxis effectiveness.

Main Results:

  • 43 (15.9%) of recipients experienced CMV infection within the first year post-SOT.
  • CMV disease showed a stronger association with negative outcomes (HR: 3.28) compared to CMV DNAemia without disease (HR: 1.42), though not statistically significant.
  • Most CMV infections occurred after antiviral prophylaxis completion; only one case of CMV disease occurred during prophylaxis.

Conclusions:

  • CMV disease is more strongly linked to adverse outcomes than asymptomatic CMV DNAemia in pediatric SOT recipients.
  • Current CMV prevention strategies should prioritize targeting CMV disease.
  • Further research may be needed to confirm statistical significance and optimize prophylaxis duration.
Abstract

Keywords:
cytomegalovirusoutcomeprophylaxisviral infection

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