Evaluation and treatment of post-renal transplant cytomegalovirus disease in children

Authors

  • Mohammed Azar Ali Department of Paediatrics, Royal Devon and Exeter Hospital, Birmingham Children Hospital, United Kingdom
  • Madeeha Sarmath MA University of Georgia, Tbilisi
  • Aadam Shah MA University of Georgia, Tbilisi
  • Fawzan Mohammed Peters School, United Kingdom

DOI:

https://doi.org/10.18203/2320-6012.ijrms20252439

Keywords:

Cytomegalovirus, IVIG, ATG, CCT

Abstract

Cytomegalovirus (CMV) infection typically presents as viremia, a clinical syndrome, or tissue-invasive disease. Identifying risk factors and conducting initial blood investigations, followed by invasive tests when appropriate, are crucial steps to rule out serious tissue-invasive disease. Ganciclovir is the cornerstone of CMV disease treatment, with oral valganciclovir used subsequently based on treatment response. For patients with UL-97 mutant ganciclovir-resistant CMV, foscarnet may be administered, often alongside intravenous immunoglobulin (IVIG), particularly in cases of life-threatening conditions such as CMV pneumonitis. Despite the significance of CMV in this population, there is currently a lack of comprehensive clinical reviews or guidelines specifically addressing the management of post-renal transplant CMV disease in children. This article aims to fill that gap by discussing the various modalities for treating post-renal transplant CMV in children, along with its clinical manifestations and necessary investigations.

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References

Stratta RJ, Shaeffer MS, Markin RS, Wood RP, Langnas AN, Reed EC, et al. Cytomegalovirus infection and disease after liver transplantation: an overview. Dig Dis Sci. 1992;37(5):673-88. DOI: https://doi.org/10.1007/BF01296422

Jordan ML, Hrebinko RL, Dummer JS, Hickey DP, Shapiro R, Vivas CA, et al. Therapeutic use of ganciclovir for invasive cytomegalovirus infection in cadaveric renal allograft recipients. J Urol. 1992;148(5):1388-92. DOI: https://doi.org/10.1016/S0022-5347(17)36918-5

Singh N, Dummer JS, Kusne S, Breinig MK, Armstrong JA, Makowka L, et al. Infections with cytomegalovirus and other herpesviruses in 121 liver transplant recipients: Transmission by donated organ and the effect of OKT3 antibodies. J Infect Dis. 1988;158(1):124-31. DOI: https://doi.org/10.1093/infdis/158.1.124

Fishburne BC, Mitrani AA, Davis JL. Cytomegalovirus retinitis after cardiac transplantation. Am J Opthalmol. 1998;125(1):104-6. DOI: https://doi.org/10.1016/S0002-9394(99)80245-1

Iragorri S, Pillay D, Scrine M, Trompeter RS, Rees L, Griffiths PD. Prospective cytomegalovirus surveillance in pediatric renal transplant patients. Pediatr Nephrol. 1993;7(1):55-60. DOI: https://doi.org/10.1007/BF00861569

Mellon A, Shepard RQ, Faoagali L, Balderson G, Ong TH, Patrick M, et al. Cytomegalovirus infection after liver transplantation in children. J Gastroenterol Hepatol. 1993;8(6):540-4. DOI: https://doi.org/10.1111/j.1440-1746.1993.tb01649.x

McCluskey PJ, Hall AJ, Lightman S. Managing HIV. Part 5: HIV and eye disease. Med J Aust. 1996;164(8):484-6. DOI: https://doi.org/10.5694/j.1326-5377.1996.tb122131.x

Quinlan MF, Salmon JF. Opthalmic complications in heart transplantation. J Heart Lung Transplant. 1993;12(2):252-5.

Sim SK, Yap HK, Murugasu B, Prabhakaran K, Ho CL. Infections in pediatric renal transplant recipients. Ann Acad Med Singapore. 1997;26(3):290-3.

Drew WL. Diagnosis of cytomegalovirus infection. Rev Infect Dis. 1988;10(3):468-75. DOI: https://doi.org/10.1093/clinids/10.Supplement_3.S468

Noble S, Faulds D. Drugs, Ganciclovir. An update of its use in the prevention of cytomegalovirus infection and disease in transplant recipients. Drugs. 1998;56(1):115-46. DOI: https://doi.org/10.2165/00003495-199856010-00012

Badley AD, Seaberg EC, Porayko MK, Wiesner RH, Keating MR, Wilhelm MP, et al. Transplantation. Prophylaxis of cytomegalovirus infection in liver transplantation: a randomized trial comparing a combination of ganciclovir and acyclovir to acyclovir. NIDDK Liver Transplantation Database. 1997;64(1):66-73. DOI: https://doi.org/10.1097/00007890-199707150-00013

Kawano Y, Mizuta K, Sanada Y, Urahashi T, Ihara Y, Okada N, et al. Risk factors of cytomegalovirus infection after pediatric liver transplantation. Transplant Proc. 2014;46(10):3543-7. DOI: https://doi.org/10.1016/j.transproceed.2014.09.150

Stratta RJ, Shaefer MS, Markin RS, Wood RP, Kennedy EM, Langnas AN, et al. Clinical patterns of cytomegalovirus disease after liver transplantation. Arch Surg. 1989;124(12):1443-9. DOI: https://doi.org/10.1001/archsurg.1989.01410120093018

Wiesner RH, Marin E, Porayko MK, Steers JL, Krom RA, Paya CV. Advances in the diagnosis, treatment, and prevention of cytomegalovirus infections after liver transplantation. Gastroenterol Clin North Am. 1993;22(2):351-66. DOI: https://doi.org/10.1016/S0889-8553(21)00072-8

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Published

2025-07-30

How to Cite

Ali, M. A., Sarmath, M., Shah, A., & Mohammed, F. (2025). Evaluation and treatment of post-renal transplant cytomegalovirus disease in children. International Journal of Research in Medical Sciences, 13(8), 3566–3569. https://doi.org/10.18203/2320-6012.ijrms20252439

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Section

Review Articles