Resumo

JULIAN NUNEZ, María Antonia et al. Frequency of infection and disease due to cytomegalovirus and risk of development in pediatric kidney transplant patients. Bol. Med. Hosp. Infant. Mex. [online]. 2012, vol.69, n.5, pp.355-366. ISSN 1665-1146.

Background. In regard to transplant-associated complications, infections represent one of the principal causes of death and graft loss. Of these, viral infections are the principal cause. The aim of this study was to determine the frequency of infection and/or disease due to cytomegalovirus (CMV) and clinical presentation in a cohort of pediatric kidney transplant patients as well as to present the risk factors associated with its development. Methods. We carried out a retrospective cohort study. Clinical files of patients who underwent kidney transplantation between 2004 and 2006 and with a minimum of 6 months of follow-up were reviewed. Active infection was considered if a positive IgM to CMV after transplant was detected or seroconversion or positive pp65 antigenemia or CMV-DNA positive PCR test. Cases represented patients with active infection or disease and controls were patients without infection and/or disease. Risk factors investigated were age, serological status previous to transplant, donor, drug prophylaxis, year of transplant and blood transfusions. Results. Of 120 transplant patients, 81 fulfilled the inclusion criteria; 53% were male and 47% female with a median age of 12 years. During follow-up, four patients presented a probable infection (4.9%), ten patients had active infection (12.3%), two patients had CMV disease (2.5%), and one patient experienced rejection plus infection (1.2%). Fifteen patients presented rejection due to different causes (18%) and 49 patients (60.5%) did not develop complications. The only significant risk factor for development of infection or disease was a previous negative serological status for CMV (OR 3.58 95% CI 0.94-14.74, p = 0.035). Frequency of infection was higher in the year 2004 (12/17 patients). Prophylaxis was administered correctly in only 28.9% of the patients. Conclusions. Frequency of CMV infection in pediatric kidney transplant patients was 20%. Among high-risk groups, frequency was 34% and decreased to 9% among low-risk groups. Most infected patients were asymptomatic, 30% presented general symptoms and 10% presented specific signs of CMV disease. Serological diagnosis was performed for most of the cases (IgM to CMV). The only significant risk factor for development of CMV infection was negative serological status for CMV previous to transplant.

Palavras-chave : cytomegalovirus; renal transplant; rejection of renal allograft.

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