Kidney Week

Abstract: TH-PO964

CMV Viraemia Is Associated with Decline in Graft Function in Paediatric Renal Transplant Recipients

Session Information

• Live Donor Outcomes and Kidney Transplantation in Pediatric and Ethnic/Racial Groups
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Transplantation

• 1702 Transplantation: Clinical and Translational

Authors

• Adalat, Shazia, Evelina London Children's Hospital, London, United Kingdom

Shazia Adalat,

• Garcia-Nicoletti, Martin, Evelina London Children's Hospital, London, United Kingdom

Martin Garcia-Nicoletti,

• Melhem, Nabil Z, Evelina London Children's Hospital, London, United Kingdom

Nabil Z Melhem,

• Walsh, Grainne M, Evelina London Children's Hospital, London, United Kingdom

Grainne M Walsh,

• Jones, Helen E, Evelina London Children's Hospital, London, United Kingdom

Helen E Jones,

• Stojanovic, Jelena, Evelina London Children's Hospital, London, United Kingdom

Jelena Stojanovic,

Background

Little is documented about impact of post-transplant CMV viraemia on graft function in paediatric renal transplant recipients.

Methods

A retrospective analysis of CMV viral loads, graft outcomes, amendments in immunosuppression (IS) and rejection episodes in renal allografts in a large paediatric transplant centre.CMV donor/recipient status, timing of CMV viraemia, duration of any antiviral therapy and time to CMV seroconversion were analysed. Rejection episodes were noted with correlation to IS changes and decline in GFR was calculated annually using the Schwartz formula.

Results

Of 101 paediatric renal transplants performed over a 5 year period (2010-15), data was analysed for 76 followed-up patients. Follow up ranged 1.3-7.3 years at time of review (mean 4.2 years). Two thirds of all transplants came from living donors and two thirds followed a standard IS protocol of basiliximab, tacrolimus, azathioprine and tapering prednisolone.
In 43% both donor and recipient were CMV naive; both were CMV seropositive in 23% and in 25% the donor was positive while recipient was naive. In 9% recipient positive only.
Of CMV naïve recipients with CMV positive donor(n=19),all received 3 months of prophylactic valganciclovir. Despite prophylaxis, 52% developed CMV viraemia at a median of 4.3mo (range 1.4-7mo). 3 of these developed CMV disease (1 hepatitis, 1 enteritis and 1 fever with neutropenia).Of the remaining 7, who had viraemia with no systemic features, 6 were on standard IS. Median time to seroconversion was 3.3 (range 0.6-54) months. Decline in graft function was 2-66 ml/min/1.73m² (median 21). Of those who didn’t develop viraemia, two grafts were lost.
Of CMV seropositive recipients, 59% (n=10/17) developed CMV viraemia 0-26 (median 1.9) months post-transplant. 9 patients were on standard IS.Decline in graft function ranged from -8 to 42 (median 8) ml/min/1.73m² from first to last follow up, compared to median decline in GFR in those without viraemia of 2(range-27 to 42) ml/min/1.73m².
No primary infection in CMV-/- or reactivation of latent infection in CMV -/+allografts was found.

Conclusion

There is a greater decline in graft function in CMV naive patients who develop viraemia regardless of seroconversion.There is no evidence that this is related to changes in immunosuppression at the time of the CMV viraemia.