PDF(Pubmed)
Abstract：
UNASSIGNED: Cytomegalovirus (CMV) is one of the most frequent opportunistic infections in kidney transplant (KT) recipients and is a risk factor for patient and graft survival after KT. Center-to-center variation, optimal prevention and treatment strategies in pediatric KT are currently unknown. This survey aimed to assess current CMV prevention and treatment strategies used among French pediatric KT centers.
UNASSIGNED: A web-based survey was sent to all 13 French pediatric kidney transplantation centers.
UNASSIGNED: Twelve (92%) centers responded to the survey. All centers used prophylaxis for the donor-positive/recipient-negative (D+/R-) group. For R + patients, 54% used prophylaxis, 37% used a pre-emptive strategy. In the low-risk group, D-/R-, 50% used a pre-emptive approach and 50% had no specific prevention strategy. The antiviral used by all centers for prophylaxis was valganciclovir (VGCV). The duration of prophylaxis varied from 3 to 7 months and the duration of viral load monitoring varied from 6 months to indefinitely. No center used a hybrid/sequential approach. For the treatment of CMV DNAemia, VGCV or intravenous GCV were used. Therapeutic drug monitoring of VGCV was performed in 5 centers (42%). Five centers reported drug resistance. Eight centers (67%) administered VGCV during the treatment of acute graft rejection.
UNASSIGNED: There is uniformity in CMV management in some areas among pediatric KT centers in France but not in others which remain diverse and are not up to date with current guidelines, suggesting unnecessary variation which could be reduced with better evidence to inform practice.
UNASSIGNED: A web-based survey was sent to all 13 French pediatric kidney transplantation centers.
UNASSIGNED: Twelve (92%) centers responded to the survey. All centers used prophylaxis for the donor-positive/recipient-negative (D+/R-) group. For R + patients, 54% used prophylaxis, 37% used a pre-emptive strategy. In the low-risk group, D-/R-, 50% used a pre-emptive approach and 50% had no specific prevention strategy. The antiviral used by all centers for prophylaxis was valganciclovir (VGCV). The duration of prophylaxis varied from 3 to 7 months and the duration of viral load monitoring varied from 6 months to indefinitely. No center used a hybrid/sequential approach. For the treatment of CMV DNAemia, VGCV or intravenous GCV were used. Therapeutic drug monitoring of VGCV was performed in 5 centers (42%). Five centers reported drug resistance. Eight centers (67%) administered VGCV during the treatment of acute graft rejection.
UNASSIGNED: There is uniformity in CMV management in some areas among pediatric KT centers in France but not in others which remain diverse and are not up to date with current guidelines, suggesting unnecessary variation which could be reduced with better evidence to inform practice.
摘要：
未经证实：巨细胞病毒（CMV）是肾移植（KT）受者中最常见的机会性感染之一，是KT后患者和移植物存活的危险因素。中心到中心的变化，小儿KT的最佳预防和治疗策略目前尚不清楚。这项调查旨在评估法国儿科KT中心目前使用的CMV预防和治疗策略。
UNASSIGNED：一项基于网络的调查被发送到所有13个法国小儿肾脏移植中心。
未经评估：12个（92%）中心对调查做出了回应。所有中心都对供体阳性/受体阴性（D/R-）组进行了预防。对于R+患者，54%使用预防,37%的人使用先发制人的策略。在低风险组中，D-/R-,50%使用先发制人的方法，50%没有具体的预防策略。所有预防中心使用的抗病毒药物是伐更昔洛韦（VGCV）。预防的持续时间从3到7个月不等，病毒载量监测的持续时间从6个月到无限期不等。没有中心使用混合/顺序方法。对于CMVDNA血症的治疗，使用VGCV或静脉内GCV。在5个中心（42％）进行了VGCV的治疗药物监测。五个中心报告了耐药性。八个中心（67％）在急性移植物排斥治疗期间给予VGCV。
UNASSIGNED：在法国的儿科KT中心的某些领域中，CMV管理具有统一性，但在其他领域中却没有，这些领域仍然存在差异，并且与现行指南不符。建议不必要的变化，可以用更好的证据来减少，以告知实践。
UNASSIGNED：一项基于网络的调查被发送到所有13个法国小儿肾脏移植中心。
未经评估：12个（92%）中心对调查做出了回应。所有中心都对供体阳性/受体阴性（D/R-）组进行了预防。对于R+患者，54%使用预防,37%的人使用先发制人的策略。在低风险组中，D-/R-,50%使用先发制人的方法，50%没有具体的预防策略。所有预防中心使用的抗病毒药物是伐更昔洛韦（VGCV）。预防的持续时间从3到7个月不等，病毒载量监测的持续时间从6个月到无限期不等。没有中心使用混合/顺序方法。对于CMVDNA血症的治疗，使用VGCV或静脉内GCV。在5个中心（42％）进行了VGCV的治疗药物监测。五个中心报告了耐药性。八个中心（67％）在急性移植物排斥治疗期间给予VGCV。
UNASSIGNED：在法国的儿科KT中心的某些领域中，CMV管理具有统一性，但在其他领域中却没有，这些领域仍然存在差异，并且与现行指南不符。建议不必要的变化，可以用更好的证据来减少，以告知实践。
