National survey of prevention and management of CMV infection in pediatric kidney transplantation in comparison to clinical practice guidelines
BackgroundCytomegalovirus (CMV) is one of the most frequent opportunistic infections in kidney transplant (KT) recipients and is a risk factor for patient and graft survival after KT. Center-to-center variation, optimal prevention and treatment strategies in pediatric KT are currently unknown. This...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-12-01
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| Series: | Frontiers in Pediatrics |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2022.1057352/full |
| _version_ | 1798006043068858368 |
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| author | Iona Madden Véronique Baudouin Marina Charbit Bruno Ranchin Gwenaëlle Roussey Robert Novo Florentine Garaix Stéphane Decramer Marc Fila Elodie Merieau Isabelle Vrillon Ariane Zaloszyc Julien Hogan Jérôme Harambat |
| author_facet | Iona Madden Véronique Baudouin Marina Charbit Bruno Ranchin Gwenaëlle Roussey Robert Novo Florentine Garaix Stéphane Decramer Marc Fila Elodie Merieau Isabelle Vrillon Ariane Zaloszyc Julien Hogan Jérôme Harambat |
| author_sort | Iona Madden |
| collection | DOAJ |
| description | BackgroundCytomegalovirus (CMV) is one of the most frequent opportunistic infections in kidney transplant (KT) recipients and is a risk factor for patient and graft survival after KT. Center-to-center variation, optimal prevention and treatment strategies in pediatric KT are currently unknown. This survey aimed to assess current CMV prevention and treatment strategies used among French pediatric KT centers.MethodsA web-based survey was sent to all 13 French pediatric kidney transplantation centers.ResultsTwelve (92%) centers responded to the survey. All centers used prophylaxis for the donor-positive/recipient-negative (D+/R-) group. For R + patients, 54% used prophylaxis, 37% used a pre-emptive strategy. In the low-risk group, D-/R-, 50% used a pre-emptive approach and 50% had no specific prevention strategy. The antiviral used by all centers for prophylaxis was valganciclovir (VGCV). The duration of prophylaxis varied from 3 to 7 months and the duration of viral load monitoring varied from 6 months to indefinitely. No center used a hybrid/sequential approach. For the treatment of CMV DNAemia, VGCV or intravenous GCV were used. Therapeutic drug monitoring of VGCV was performed in 5 centers (42%). Five centers reported drug resistance. Eight centers (67%) administered VGCV during the treatment of acute graft rejection.ConclusionsThere is uniformity in CMV management in some areas among pediatric KT centers in France but not in others which remain diverse and are not up to date with current guidelines, suggesting unnecessary variation which could be reduced with better evidence to inform practice. |
| first_indexed | 2024-04-11T12:48:42Z |
| format | Article |
| id | doaj.art-8a03648a09b94c63951c62186d9ce4bd |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-04-11T12:48:42Z |
| publishDate | 2022-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-8a03648a09b94c63951c62186d9ce4bd2022-12-22T04:23:16ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602022-12-011010.3389/fped.2022.10573521057352National survey of prevention and management of CMV infection in pediatric kidney transplantation in comparison to clinical practice guidelinesIona Madden0Véronique Baudouin1Marina Charbit2Bruno Ranchin3Gwenaëlle Roussey4Robert Novo5Florentine Garaix6Stéphane Decramer7Marc Fila8Elodie Merieau9Isabelle Vrillon10Ariane Zaloszyc11Julien Hogan12Jérôme Harambat13Pediatric Nephrology Unit, Bordeaux University Hospital, Bordeaux, FrancePediatric Nephrology Unit, Robert Debré Hospital, APHP, Paris, FrancePediatric Nephrology Unit, Hôpital Necker Enfants Malades, APHP, Paris, FrancePediatric Nephrology Unit, Hospices Civils de Lyon, Lyon, FrancePediatric Nephrology Unit, Nantes University Hospital, Nantes, FrancePediatric Nephrology Unit, Lille University Hospital, Lille, FrancePediatric Nephrology Unit, AP-Hôpitaux de Marseille, Marseille, FrancePediatric Nephrology Unit, Toulouse University Hospital, Toulouse, FrancePediatric Nephrology Unit, Montpellier University Hospital, Montpellier, France0Pediatric Nephrology Unit, Tours University Hospital, Tours, France1Pediatric Nephrology Unit, Nancy University Hospital, Nancy, France2Pediatric Nephrology Unit, Strasbourg University Hospital, Strasbourg, FrancePediatric Nephrology Unit, Robert Debré Hospital, APHP, Paris, FrancePediatric Nephrology Unit, Bordeaux University Hospital, Bordeaux, FranceBackgroundCytomegalovirus (CMV) is one of the most frequent opportunistic infections in kidney transplant (KT) recipients and is a risk factor for patient and graft survival after KT. Center-to-center variation, optimal prevention and treatment strategies in pediatric KT are currently unknown. This survey aimed to assess current CMV prevention and treatment strategies used among French pediatric KT centers.MethodsA web-based survey was sent to all 13 French pediatric kidney transplantation centers.ResultsTwelve (92%) centers responded to the survey. All centers used prophylaxis for the donor-positive/recipient-negative (D+/R-) group. For R + patients, 54% used prophylaxis, 37% used a pre-emptive strategy. In the low-risk group, D-/R-, 50% used a pre-emptive approach and 50% had no specific prevention strategy. The antiviral used by all centers for prophylaxis was valganciclovir (VGCV). The duration of prophylaxis varied from 3 to 7 months and the duration of viral load monitoring varied from 6 months to indefinitely. No center used a hybrid/sequential approach. For the treatment of CMV DNAemia, VGCV or intravenous GCV were used. Therapeutic drug monitoring of VGCV was performed in 5 centers (42%). Five centers reported drug resistance. Eight centers (67%) administered VGCV during the treatment of acute graft rejection.ConclusionsThere is uniformity in CMV management in some areas among pediatric KT centers in France but not in others which remain diverse and are not up to date with current guidelines, suggesting unnecessary variation which could be reduced with better evidence to inform practice.https://www.frontiersin.org/articles/10.3389/fped.2022.1057352/fullcytomegaloviruspediatric kidney transplantprophylaxissurveyvalganciclovir |
| spellingShingle | Iona Madden Véronique Baudouin Marina Charbit Bruno Ranchin Gwenaëlle Roussey Robert Novo Florentine Garaix Stéphane Decramer Marc Fila Elodie Merieau Isabelle Vrillon Ariane Zaloszyc Julien Hogan Jérôme Harambat National survey of prevention and management of CMV infection in pediatric kidney transplantation in comparison to clinical practice guidelines Frontiers in Pediatrics cytomegalovirus pediatric kidney transplant prophylaxis survey valganciclovir |
| title | National survey of prevention and management of CMV infection in pediatric kidney transplantation in comparison to clinical practice guidelines |
| title_full | National survey of prevention and management of CMV infection in pediatric kidney transplantation in comparison to clinical practice guidelines |
| title_fullStr | National survey of prevention and management of CMV infection in pediatric kidney transplantation in comparison to clinical practice guidelines |
| title_full_unstemmed | National survey of prevention and management of CMV infection in pediatric kidney transplantation in comparison to clinical practice guidelines |
| title_short | National survey of prevention and management of CMV infection in pediatric kidney transplantation in comparison to clinical practice guidelines |
| title_sort | national survey of prevention and management of cmv infection in pediatric kidney transplantation in comparison to clinical practice guidelines |
| topic | cytomegalovirus pediatric kidney transplant prophylaxis survey valganciclovir |
| url | https://www.frontiersin.org/articles/10.3389/fped.2022.1057352/full |
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