Antiviral Therapeutics in Pediatric Transplant Recipients

A quick algorithmic review on management of viral infectious diseases in pediatric solid organ transplant recipients

“…For those SOT recipients who are seropositive for VZV and not taking antiviral medication for CMV or HSV prophylaxis (which is a rare situation), it is recommended to consider administering (val)acyclovir for at least one month after the transplantation ( Figure 5 ) ( 9 , 40 , 48 ).…”

“…All SOT children with confirmed or suspected influenza should take antiviral treatment as soon as possible after symptom onset, preferably within 48 h ( 61 ). Oral oseltamivir is the preferred medication for treatment of influenza due to more information on its effectiveness in pediatric transplant recipients ( 9 ). The usual duration of antiviral therapy with oseltamivir is 5 days; an extended duration may be needed in patients with long-term clinical symptoms ( Figure 6 ) ( 61 , 62 ).…”

“…Experiences with zanamivir, peramivir, and baloxavir are lacking in pediatric transplant patients. Intravenous formulations (zanamivir or peramivir) may be used in severely ill patients or those unable to tolerate oral drugs ( 9 ). In addition, antiviral therapy should be considered for symptomatic individuals who reside with SOT recipients, particularly severely immunocompromised ones ( 52 , 62 ).…”

“…Despite improvements in managing post-transplant infections during past 20 years, viral infections remain a significant factor affecting graft function and overall transplantation outcomes. Among this vulnerable population, delayed detection and management of viral infections can lead to significant levels of morbidity and mortality ( 8 , 9 ). The most commonly observed viral infections following solid organ transplantation include CMV, EBV, HSV, VZV, adenoviruses, BK polyomavirus, and respiratory viruses like Influenza ( 10 , 11 ).…”