Simulect and HHV-6 in pediatric renal transplantation

• Published in: Transplantation proceedings 2004-03, Vol.36 (2), p.S483-S486
• Main Authors: Acott, P.D, Crocker, J.F.S, Lee, S
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - therapeutic use; Antibodies, Monoclonal - therapeutic use; Antibodies, Viral - blood; Child; Child, Preschool; Drug Monitoring; Herpesvirus 6, Human - isolation & purification; Humans; Immunoglobulin M - blood; Immunosuppressive Agents; Kidney Transplantation - immunology; Male; Methylprednisolone - therapeutic use; Postoperative Complications - epidemiology; Postoperative Complications - virology; Postoperative Period; Prednisone - therapeutic use; Recombinant Fusion Proteins - therapeutic use; Roseolovirus Infections - epidemiology
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2003.12.041

Herpes virus reactivation is of increasing interest as we aim to decrease morbidity and mortality in the pediatric renal transplant population. We previously reported increased reactivation of HHV-6 and Epstein Barr virus (EBV) with anti-thymocyte globulin/ALG induction therapy. HHV-6 reactivation and de novo infection has been monitored in 31 consecutive pediatric renal transplant patients receiving antibody induction with Simulect. Human Herpes virus-6 (HHV-6) was correlated with EBV reactivation and de novo infection rates, allograft function at 1 year, donor source and number, and patient age and gender. One HHV-6 de novo infection was associated with an early grade II rejection that was steroid resistant but ATG/ALG responsive. Sixteen of 31 (54.8%) patients had HHV-6 reactivation during the first year and eight patients had a prior reactivation profile before transplant. Thirteen patients (41.9%) were naïve to EBV infection prior to transplant with evidence of primary infection in 11 of 13 patients between 6 weeks and 1 year posttransplant. EBV reactivation was noted in four patients with past immunity to EBV. IgM Ab to EBV or HHV-6 during the first year posttransplant did not correlate with risk of rejection during the first year or graft function one year posttransplant. The only patient with positive HHV-6 IgM Ab in the first posttransplant month was a de novo infection in a 2-year-old boy who was naïve for HHV-6 at the time of transplant. Simulect appears safe in pediatric renal transplant with low risk of HHV-6 or EBV infection in the first 1 to 2 months posttransplant.