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Cytomegalovirus (CMV) Infection is infrequently seen after kidney Transplantation (KTX) in children. The seropositivity of this CMV is quite common in both donors and recipients before KTX, and together with heavy immunosuppression constitute risk factors for activation of CMV infection post KTX. Therefore the use of viral prophylaxis for 100-200 days is considered, which help in reducing the risk with the known possibilities of flaring up of infection after discontinuation of viral prophylaxis. All KTX recipients usually monitor with regular blood CMV Polymerase chain reaction (CMV PCR) after that.
A retrospective review of all children underwent KTX between 2009 and 2022. We collected their Baseline demographics, type of KTX, their primary kidney diseases, induction and maintenance immunosuppression’s used, duration of Viral prophylaxis, as well as number of recipients who developed CMV infection and associated systemic manifestations, if any, and their response to antiviral treatment.
A 76 children underwent KTX. A total of 56 and 14 child received oral Valganciclovir as viral prophylaxis for 200 and 100 days respectively. 6 children didn't require viral prophylaxis. Nine Patients developed CMV infection within a range of 1-4 months after discontinuation of viral prophylaxis, 6 and 3 cases of those who received 200 and 100 days of viral prophylaxis respectively. All patients diagnosed based on increase CMV PCR only without systemic manifestations except for two with acute hepatitis and acute encephalitis each, both where from the group that received 200 days of viral prophylaxis. All patients have been managed with holding Mycophenolate mofetil (MMF) and intravenous Ganciclovir, followed by secondary prophylaxis with oral Valganciclovir for 100 days with resuming of MMF immediately after negativity of CMV PCR, with recovery of all patients. Subsequently no further flaring up of CMV infections were encountered in all the patients. The one with acute hepatitis has recovered, and that with acute encephalitis has left with some kind of neurological deficit that required rehabilitation. None of the patients have developed associated acute cellular rejection. None of these CMV infection compromise Allograft or Patient Survival.
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CMV infection can develop infrequently after KTX. Optimal viral prophylaxis with regular monitoring of CMV PCR after its discontinuation lead to earlier detection and prompt treatment.