Introduction
Viral infections are known to be a risk factor for chronic graft injury and poor graft function. The purpose of this study was to describe the frequency, risk factors and outcome of viral infections (CMV, EBV and BKV) in pediatric kidney transplant recipients over a decade.
Methods
Data of infection, immunosuppression and graft outcome were retrieved from medical files of all pediatric kidney transplant recipients (Age 0-18 years), transplanted at our center between January 2006 to December 2015 and followed-up for at least 2 years.
Results
69 kidney transplantations met inclusion criteria. In 24 (34.8%) patients 27 episodes of viremia were diagnosed at mean follow up of 5.26±2.4 years. 16 viremias were symptomatic. There was no death or graft loss due to viral infection.
Risk factors for infection compared to patients with no infection were younger age at transplantation: 10.46±4.3 years vs. 12.6±3.9; (p=0.03) and the use of ATG for induction 18.5% vs. 2.3%; (p=0.023).
During the last two years of the study we observed an increase in viremia rates (54% vs 28% of patients in previous years), that paralleled a statistically significant increase in mycophenolate mofetil dosing.
In outcome analysis There was no difference in graft loss and eGFR at last follow up between patients with infection and those without: 11.1% vs. 6.8% (p=0.67); 56.6±22.9 vs. 62.0±24.7 (p=0.35) respectively.
Conclusions
Viral infections continue to be a major cause of morbidity in pediatric kidney transplant recipients. However, the favorable outcome of our cohort may be explained by close monitoring and prompt intervention at the time of infection diagnosis.
