Antiviral agents for preventing cytomegalovirus infection in pediatric renal transplant recipients: A systematic review

Background and Objective: Cytomegalovirus (CMV) infections are associated with severe morbidity and mortality in patients, especially pediatric renal transplantation patients. The use of immunosuppressive agents places these patients at the risk of viral infections. As cytomegalovirus infection influences the graft outcome, adopting useful strategies for limiting this virus after transplantation seems necessary. Methods: This systematic review evaluates all articles about the prophylactic treatment in pediatric renal graft recipients. Results: There are several anti-viral agents that are used alone or in combination for preventing CMV infection. The prophylactic agents that are used in pediatric recipients include CMV-Ig, IVIG, acyclovir/valacyclovir, and ganciclovir/valganciclovir. CMV-Ig is an adjective agent and it is less effective if used alone.  Although performed studies in children are not sufficient to determine valacyclovir effect in preventing reactivation of cytomegalovirus, valacyclovir is used in moderate risk recipients for CMV infection. It seems that valacyclovir is less effective than valganciclovir. Conclusion: Nowadays oral valganciclovir is the most appropriate prophylactic agent used in most transplant centers for children and adults.  However it appears that valganciclovir prevents cytomegalovirus infection only during prophylaxis period. The incidence of late CMV infection does not reduce by this drug. Some trials in adults and a retrospective study in children recommend that longer duration of prophylaxis with valganciclovir lowers the incidence of CMV infection in late stage.