| Autor: |
Li L; Department of Pediatrics, Stanford University, Palo Alto, CA, USA., Chaudhuri A, Weintraub LA, Hsieh F, Shah S, Alexander S, Salvatierra O Jr, Sarwal MM |
| Jazyk: |
angličtina |
| Zdroj: |
Pediatric transplantation [Pediatr Transplant] 2007 Mar; Vol. 11 (2), pp. 187-95. |
| DOI: |
10.1111/j.1399-3046.2006.00641.x |
| Abstrakt: |
Post-transplant clinical disease with cytomegalovirus (CMV) and Epstein-Barr virus (EBV) is a known risk factor for graft dysfunction and lymphoproliferation. We postulate that subclinical, asymptomatic viremia also adversely impacts outcomes, and may warrant re-assessment of current monitoring and antiviral prophylaxis protocols. A single-center study was conducted on 102 pediatric (51 steroid-free and 51 matched steroid-based historical controls). Quantitative viral loads were serially monitored and correlated with outcome measures. Overall, the incidence of CMV and EBV clinical disease was 5% (1% CMV and 4% EBV); however, the incidence of subclinical viremia was 44% (12.7% CMV, 38.2% EBV, 6.9% CMV + EBV). Risk factors for subclinical viremia were EBV naivety (p = 0.07), age less than five yr (p = 0.04), lack of prophylaxis (p = 0.01), and steroid usage (p = 0.0007). Subclinical viremia was associated with lower three-yr graft function (p = 0.03), increased risk of acute rejection (odds ratio 2.07; p = 0.025), hypertension (p = 0.04), and graft loss (p = 0.03). Subclinical asymptomatic CMV and EBV viremia is a risk factor for graft injury and loss. These findings support the need for aggressive, serial viral monitoring to better determine the appropriate length of post-transplant antiviral prophylaxis, and to determine the effect of immunosuppression protocols on the development of viremia. |
| Databáze: |
MEDLINE |
| Externí odkaz: |
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