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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2019  |  Volume : 30  |  Issue : 4  |  Page : 1000-1001
Probability of Ganciclovir Resistance in Cytomegalovirus-Infected Pediatric Kidney Transplant Recipients after Cessation of Standard Antiviral Prophylaxis: Estimated Risk on Thai cases


1 KMT Primary Care Center, Bangkok, Thailand
2 Faculty of Medicine, University of Nis, Nis, Serbia; Joseph Ayobabalola University, Ikeji-Arakeji, Nigeria

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Date of Submission31-Oct-2018
Date of Acceptance05-Nov-2018
Date of Web Publication27-Aug-2019
 

How to cite this article:
Yasri S, Wiwanitkit V. Probability of Ganciclovir Resistance in Cytomegalovirus-Infected Pediatric Kidney Transplant Recipients after Cessation of Standard Antiviral Prophylaxis: Estimated Risk on Thai cases. Saudi J Kidney Dis Transpl 2019;30:1000-1

How to cite this URL:
Yasri S, Wiwanitkit V. Probability of Ganciclovir Resistance in Cytomegalovirus-Infected Pediatric Kidney Transplant Recipients after Cessation of Standard Antiviral Prophylaxis: Estimated Risk on Thai cases. Saudi J Kidney Dis Transpl [serial online] 2019 [cited 2019 Sep 21];30:1000-1. Available from: http://www.sjkdt.org/text.asp?2019/30/4/1000/265448


To the Editor,

The cytomegalovirus (CMV) infection is an important virus infection. It is an important infectious disease among immunocompromised hosts including renal transplant recipients.[1] In general, standard antiviral prophylaxis is recommended for all renal transplant recipients. However, there is still a chance that the CMV DNAemia can occur after cessation of standard antiviral prophylaxis.[2] Some renal transplant recipients with CMV DNAemia might further develop CMV disease.[2] Among those with disease, ganciclovir resistance has been observed and such cases are difficult to manage.

Herein, the authors report a probability analysis to estimate risk for ganciclovir resistance in CMV-infected pediatric kidney transplant recipients after cessation of standard antiviral prophylaxis. The studied setting is Thailand, a tropical country in Indochina, where CMV infection is very common.[3] For risk assessment, the standard path probability analysis was done. The primary data for the analysis included the data on CMV DNAemia rate among pediatric kidney transplant recipients after cessation of standard antiviral pro-phylaxis,[2] and the prevalence of ganciclovir resistance among solid organ transplant recipients,[4] which are available in the previous studies in our setting. The final estimated risk is derived from joint probability calculation, which is the result from multiplication of componential probability.

Regarding the primary available data,[3] the rate between donor seropositive, recipient seronegative (D + R-), and CMV recipient seropositive (R+) is equal to 1:1.457 or 40.7%:59.3%. The CMV DNAemia rates for (D + R-) and (R+) were 22.9% and 23.5%, respectively. Regarding the incidence of CMV disease, the rates among (D + R-) and (R+) were 11.4% and 0%, respectively. The reported incidence of ganciclovir resistance among solid organ transplant recipients with CMV disease is 33.3%.[4] The path probability analysis is done as shown in [Table 1]. According to the path probability analysis, the finalized risk of ganciclovir resistance in CMV-infected pediatric kidney transplant recipients after cessation of standard antiviral prophylaxis was 0.37% of all risk transplantation cases (both [D + R-] and [R+]), and the risk occurs in only the (D + R) group. This implies the necessity for good donor screening for CMV, and if possible, CMV-positive donor should be avoided.
Table 1: Path probability analysis for probability of ganciclovir resistance in pediatric kidney transplant

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Conflict of interest: None declared.



 
   References Top

1.
Koval CE. Prevention and treatment of Cytomegalovirus infections in solid organ transplant recipients. Infect Dis Clin North Am 2018;32:581-97.  Back to cited text no. 1
    
2.
Chaiyapak T, Borges K, Williams A, et al. Incidence of Cytomegalovirus DNAemia in pediatric kidney transplant recipients after cessation of antiviral prophylaxis. Transplantation 2018;102:1391-6.  Back to cited text no. 2
    
3.
Tantivanich S, Suphadtanaphongs V, Siripanth C, et al. Prevalence of Cytomegalovirus antibodies among various age groups of Thai population. Southeast Asian J Trop Med Public Health 1999;30:265-8.  Back to cited text no. 3
    
4.
Bruminhent J, Rotjanapan P, Watcharananan SP. Epidemiology and outcome of ganciclovir-resistant Cytomegalovirus infection after solid organ transplantation: A single transplant center experience in Thailand. Transplant Proc 2017;49:1048-52.  Back to cited text no. 4
    

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Correspondence Address:
Sora Yasri
KMT Primary Care Center, Bangkok
Thailand
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DOI: 10.4103/1319-2442.265448

PMID: 31464265

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