Prophylaxis with valganciclovir (VGCV) is used routinely to prevent cytomegalovirus (CMV) infections in at-risk pediatric solid organ transplant (SOT) recipients. However, the rate and factors associated with toxicities in this population are not well-described. We conducted a retrospective cohort study of children undergoing SOT at our hospital from January 2012–June 2018. We evaluated the frequency of hematologic and renal toxicities from day 15 through 1-year post-SOT in relation to antiviral exposures, focused on VGCV prophylaxis. Marginal rate models were used to determine the risk of kidney injury and neutropenia in relation to VGCV prophylaxis. Among 281 SOTs, VGCV prophylaxis was administered on 20.1% of all follow-up days. The incidence rates of kidney injury, leukopenia, and neutropenia were significantly higher during VGCV prophylaxis compared to when no antiviral agents were given. Using multivariable marginal rate models, receipt of VGCV prophylaxis was associated with development of kidney injury (rate ratio [RR] 1.79, 95% confidence interval [CI]: 1.22–2.65) and neutropenia (RR 4.82, 95% CI: 3.08–7.55). VGCV dosing did not impact the development of kidney injury or neutropenia. Toxicities are common with VGCV prophylaxis in pediatric SOT recipients.

中文翻译：

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儿科实体器官移植受者的抗病毒毒性

缬更昔洛韦 (VGCV) 的预防通常用于预防高危儿科实体器官移植 (SOT) 受者的巨细胞病毒 (CMV) 感染。然而，该人群中与毒性相关的发生率和因素并未得到很好的描述。我们对 2012 年 1 月至 2018 年 6 月在我们医院接受 SOT 的儿童进行了一项回顾性队列研究。我们评估了 SOT 后第 15 天至 1 年的血液学和肾脏毒性的频率与抗病毒暴露的相关性，重点是 VGCV 预防。边际率模型用于确定与 VGCV 预防相关的肾损伤和中性粒细胞减少的风险。在 281 个 SOT 中，20.1% 的随访日进行了 VGCV 预防。肾损伤、白细胞减少症的发生率，与未给予抗病毒药物时相比，在 VGCV 预防期间显着更高。使用多变量边际率模型，接受 VGCV 预防与肾损伤（率比 [RR] 1.79，95% 置信区间 [CI]：1.22–2.65）和中性粒细胞减少症（RR 4.82，95% CI：3.08–7.55）的发展相关). VGCV 给药不会影响肾损伤或中性粒细胞减少症的发展。在儿科 SOT 接受者中，VGCV 预防的毒性很常见。