Prospective, comprehensive, and effective viral monitoring in Cuban children undergoing solid organ transplantation

Abstract

PurposeIn Cuba, viral monitoring in the post-transplant period was not routinely performed. The aim of this research is to identify the most frequent viruses that affect transplanted Cuban children, by implementing a viral follow-up during the post-transplant period.MethodsThe study population included all Cuban pediatric patients who underwent solid organ transplantation (SOT) between November 2009 and December 2012. A total of 34 transplanted pediatric patients of kidney (n = 11) and liver (n = 23) were prospectively monitored during a 34-week period for viral DNAemia and DNAuria by simultaneous detection of cytomegalovirus (CMV), Epstein-Barr virus, herpes simplex virus type 1 and 2, varicella zoster virus, human herpesvirus 6, human adenovirus, and polyomaviruses (BKV and JCV) using quantitative real-time polymerase chain reaction (qRT-PCR).ResultsViral genome of at least one virus was detected in 21 of 34 recipients, 18 patients excreted virus in urine while 12 presented DNAemia. CMV (41.2%) and BKV (35.3%) were the most frequent viruses detected during the follow-up. CMV was the virus mainly associated with clinical symptoms and DNAemia. Its excretion in urine (with cut off value of 219 copies/mL) was associated with detection in plasma (p < 0.001); furthermore, CMV viruria was predictive of CMV viremia (OR:8.4, CI:2.4-29.1, p = 0.001). There was no association between high viral load and clinical complications, due to the prompt initiation of preemptive ganciclovir. Conclusion: This comprehensive viral monitoring program effectively prevents the development of critical viral disease, thus urge the implementation of qRT-PCR as routine for viral monitoring of transplanted Cuban organ recipients.

HHV‐6 in liver transplantation: A literature review

“…CMV prophylaxis (valganciclovir) was administered to 39% of the non‐monitored group and 30% of the monitored group, and only one out of 23 episodes (4.3%) of HHV‐6 viraemia occurred in patients receiving prophylaxis (Table ) . Another study of 23 paediatric liver transplant patients who received ganciclovir/valganciclovir prophylaxis, reported similar results, detecting HHV‐6 in just one patient (4.3%) …”

Herpesviruses excretion in saliva of pediatric transplant recipients

“…The study was analyzed as a case‐control study in which the first sample was considered as the control sample. The patients included in this research were part of a previously published article …”

Pediatric liver transplantation in Latin America: Where do we stand?

“…Kouri et al, in a study enrolling all children transplanted in Cuba between 2009 and 2012 for viral monitoring post‐transplantation, included 23 children who underwent LT. The one‐yr survival was 87% . There is no information about allocation policy in the national website.…”