Cytomegalovirus Infection Following Renal Transplantation – an Overview (original) (raw)
Related papers
einstein (São Paulo), 2015
Cytomegalovirus infection is one of most frequent infectious complications after renal transplantation, and can be classified as primo-infection, when the transmission occurs through the graft, or reactivation, when the recipient is cytomegalovirus seropositive. After transplantation, cytomegalovirus can appear as an infection, when the patient presents with evidence of viral replication without symptoms or disease, which has two clinical spectra: typical viral syndrome or invasive disease, which is a less common form. Their effects can be classified as direct, while the disease is developed, or indirect, with an increase of acute rejection and chronic allograft dysfunction risks. Diagnosis must be made based on viremia by one of the standardized methods: antigenemia or PCR, which is more sensitive. The risk factors related to infection after transplantation are the serologic matching (positive donor and negative recipient) and anti-lymphocyte antibody drugs. One of the strategies to reduce risk of disease should be chosen for patients at high risk: preemptive treatment or universal prophylaxis. Recent clinical research has described ganciclovir resistance as an emergent problem in management of cytomegalovirus infection. Two types of mutation that cause resistance were described: UL97 (most frequent) and UL54. Today, sophisticated methods of immunologic monitoring to detect specific T-cell clones against cytomegalovirus are used in clinical practice to improve the management of high-risk patients after renal transplantation.
Management and Prevention of Cytomegalovirus Infection After Renal Transplantation
Mayo Clinic Proceedings, 1992
We reviewed the epidemiologic characteristics, diagnosis, clinical features, and management of cytomegalovirus (CMV) infection after renal transplantation. CMV, the major viral pathogen after renal transplantation, increases patient morbidity and mortality. The spectrum of CMV infection ranges from latent infection to asymptomatic viral shedding to life-threatening multisystem disease. The two major risk factors for the development of CMV infection in renal transplant recipients are (1) preexisting CMV antibody seropositivity of either the organ donor or the recipient and (2) host immunosuppression. Blood cultures (but not urine cultures) positive for CMV predict the progression of asymptomatic infection to CMV disease, characterized by fever, malaise, myalgia, leukopenia, abnormal transaminase levels, and often involvement of the lung and gut. New genomic methods of viral detection now offer diagnostic advantages, including methods of detecting only actively replicating CMV. No evidence shows that CMV directly causes allograft rejection or glomerulonephritis, but patients with tissue-invasive CMV disease have higher rates of allograft loss and mortality than do those without the disease. Therapy for established CMV disease includes decreasing the immunosuppressive therapy and administering the antiviral agent ganciclovir sodium. Proven prophylactic strategies include limitation of exposure to the virus from CMV seropositive blood or organ donors, administration of CMV-specific immune globulin, and use of high-dose acyclovir therapy. Preemptive therapy with ganciclovir is a promising alternative to propbylaxis for patients at highest risk for progression to symptomatic CMV disease, such as those with CMV viremia and seropositive recipients receiving antilymphocyte therapy. Cytomegalovirus (CMV) is a DNA herpesvirus that silently infects up to 90% of the adult population.' CMV has long been recognized as the major viral pathogen during the first months after renal transplantation.' In a review of the literature, Glenn" estimated that CMV causes symptomatic disease in 35% and death in 2% of recipients of renal trans
Transplantation Proceedings, 2012
Introduction. Renal transplantation is regarded as the optimal treatment for patients with end-stage renal disease. Despite significant improvements in surgical techniques and immunosuppressive therapy, long-term graft survival has not markedly increased over the years, due in part to the occurrence of cytomegalovirus (CMV) infection. Patients and Methods. Between January 2001 and September 2011, we performed 592 kidney transplantations (214 living and 378 cadaveric donors). All patients received induction therapy with interleukin (IL)-2 monoclonal antibodies or antithymoglobulin (ATG) combined with calcineurin inhibitors, mycophenolate mofetil, or mTOR antagonists and steroids. All CMV-seronegative patients and all subjects receiving ATG induction were prescribed prophylactic therapy with ganciclovir-intravenous (IV) for 15 days 2.5 mg/kg BW bid and thereafter oral valgancyclovir once a day. CMV infection was diagnosed using a CMV-PVR of Ն600 copies. We analyzed the time to manifestations of CMV infection, or positive CMV-PCR, patient and graft survival, serum creatinine (Cr), and blood urea nitrogen (BUN) values before and after CMV infection, as well as type of immunosuppression therapy. Results. The overall incidences of CMV infection and CMV disease were 76/592 (12.8%) and 23/592 (3.9%), respectively. The mean Ϯ standard deviation (SD) times to positive CMV-PCR and CMV disease were 16.66 Ϯ 23.38 months and 106 Ϯ 61.2 (range, 28-215) days, respectively. Mortality was 1% (6/592) among our whole population, 7.9% (6/76) for CMV-infected, and 26% (6/23) in the CMV disease cohort. Cr and BUN showed no significant differences among the groups. Conclusions. CMV infection and CMV disease comprise significant clinical problems, increasing morbidity and mortality. The use of prophylactic anti-CMV treatment is of paramount importance. R ENAL transplantation is regarded as the optimal treatment for patients with end-stage renal disease. Despite significant improvements in surgical techniques and in immunosuppressive therapy, long-term graft survival has not markedly increased over the years in part due to cytomegalovirus (CMV) infection. 1,2 CMV, a human herpesvirus 5 belonging to the Betaherpesvirinae, is the most important viral pathogen after kidney transplantation. In the absence of preventive measures, 40%-100% of all recipients develop a CMV infection and up to 67% develop CMV disease. 3-5 The seroprevalence of CMV among the general population ranges from 30%-97%, increasing with age. It can be transmitted by blood transfusion, saliva, urine, placental transfer, breastfeeding,
Human Cytomegalovirus and Kidney Transplantation: A Clinician's Update
American Journal of Kidney Diseases, 2011
Infection with human cytomegalovirus (CMV) is an important cause of morbidity and mortality in kidney transplant recipients. CMV disease is diagnosed based on the detection of viral replication by phosphoprotein 65 antigenemia or CMV DNA polymerase chain reaction in combination with typical signs and symptoms. Risk factors include CMV-seronegative recipients receiving a CMV-seropositive transplant, older donor age, exposure to cyclosporine and/or antilymphocyte antibody, rejection episodes, and impaired transplant function. Current preventive strategies in kidney transplant recipients include pre-emptive therapy with valganciclovir or intravenous ganciclovir and universal prophylaxis with valacyclovir, valganciclovir, or ganciclovir for 3-6 months after kidney transplantation and for 1-3 months after treatment with antilymphocyte antibody. Established disease should be treated using either intravenous ganciclovir or oral valganciclovir until CMV replication can no longer be detected. In addition to direct effects, CMV infection also induces a wide range of indirect effects, such as decreased transplant and recipient survival and susceptibility to rejection and opportunistic infections. In this review, we highlight the most relevant topics on CMV and kidney transplantation based on current evidence and guidelines. Am J Kidney Dis. 58(1):118-126.
Cytomegalovirus infection in renal transplant patients
2008
A prospective study of cytomegalovirus (CMV) infection was carried out on 34 renal transplant recipients managed at a General Hospital in Ribeirão Preto, SP, Brazil. Serologic tests showed that all patients were infected with CMV before renal transplantation. Two nested-PCR techniques with primers that recognize sequences of the glycoprotein B (gB) and H (gH) genes were used for CMV detection in blood and urine samples during the post-transplantation period. CMV was detected more frequently in blood samples than in urine samples (P<0.001). Thirty-three patients had CMV detected at least once in blood and/or urine samples. Seven of these patients (21.2%) were diagnosed as having symptomatic CMV infection and showed a worse clinical outcome, with a higher death rate (P = 0.03). No association between CMV viremia and graft rejection was observed. Nested-PCR was not useful to identify patients at risk for symptomatic CMV infection since only 21.2% of the patients with CMV infection were symptomatic.
The incidence of cytomegalovirus infection in renal transplant patients : single-center study
Panomvana Na Ayudhaya D, Praditpornsilpa K, Tewthanom K. The incidence of cytomegalovirus infection in renal transplant patients: single-center study. Chula Med J 2004 Jun; 48(6): 343 -55 Background and objective Cytomegalovirus (CMV) infection is a serious problem in renal transplant patients. The purpose of this study was to determine the incidence of CMV infection in Thai renal transplant recipients. Setting and methods The data were collected from medical records of patients who had renal transplantation from January 1998 to December 2002 at the Nephrology Unit, King Chulalongkorn Memorial Hospital. Design Descriptive retrospective analysis. Results The information of 91 out of 114 renal transplanted patients at the Nephrology Unit were retrieve and analyzed. They were 47 men and 44 women. Their mean age was 41.89 + 11.82 years and the mean year of transplantation was 2.51+ 1.53 years. Most patients (46.2 %) had end-stage renal failure from unknown causes, while 13.2 % were diabetes nephropathy, and 14.3 % were chronic glomerulonephritis respectively. More than half (64.8%) of the patients received cadaveric renal transplantation while the rest (35.2 %) received living related donors. Eighty-three of patients (91.2 %) had seropositive CMV antibodies (IgM or IgG) in both donors and recipients (D+/R+). Four patients (4.4 %) had D-/R-; three : : : : นิ พนธ์ ต้ นฉบั บ 344 ดวงจิ ต พนมวั น ณ อยุ ธยา และคณะ Chula Med J patients (3.3 %) had D-/R+; and only one patient (1.1 %) had D+/R-. Triple immunosuppressive agents were used in all patients at the early post transplantation. Nine of eighty-three (11 %) seropositive patients (D+/R+) got CMV infection. All CMV infections were diagnosed during the first 7 months after transplantation. Among the 91 investigated patients, 31 (34.06 %) patients had their cyclosporine levels higher than the therapeutic ranges while the rests were within targeted ranges. Seven out of ten (70 %) patients who got CMV infection had their cyclosporine concentrations higher than targeted ranges. Therefore the proportion of CMV infections were significantly higher in the group that had cyclosporine higher than therapeutic level as compared to the group that had within the therapeutic level (p=0.011). Antiviral drugs were used for pre-emptive and secondary prophylaxis therapy. Ganciclovir was the main drug used for standard treatment and prophylaxis. Most patients could tolerate the antiviral therapy. Eight patients (80 %) were improved, one patient (10 %) suffered from graft rejection and one patient (10 %) died.
Cytomegalovirus Disease in Renal Transplant Recipients: A Single-Center Experience
Indian Journal of Microbiology, 2012
Cytomegalovirus (CMV) is the most common viral infection following kidney transplant, has been recognized as a major factor for graft loss and increased incidence of acute rejection. Different studies have reported a variable incidence of CMV disease with the use of Mycophenolate mofetil (MMF). We retrospectively analyzed our renal transplant recipients to review the results of CMV disease and to compare CMV disease in patient on Azathioprine and MMF for this purpose we retrospectively reviewed 521 live related kidney transplant recipients at our institute. 74 (14.2 %) live related allograft recipients developed CMV disease after a median interval of 7.18 ± 4.35 months from transplantation. The mean age was 36.15 ± 10.7 years. 63 of the patients were male. Malaise, fever and diarrhea were among most common symptoms. 20 (27.02 %) of the 74 recipients developed transaminitis, 13 (17.2 %) developed CMV gastritis, 5 (9.13 %) recipients developed pneumonia, and 3 (4.05 %) patient developed colitis. 59 (80 %) patients had leucopenia and 41 (56.5 %) developed thrombocytopenia. Mean serum creatinine level was 1.5 ± 0.4 (0.9-2.4) mg/dl before the disease, 1.9 ± 0.6 (1.3-3.6) mg/dl at the time of the diagnosis, and 1.7 ± 0.06 (0.8-4.2) mg/dl at the end of the treatment. CMV disease developed in 9 (36 %) of recipients who received basiliximab as induction therapy and 13 (30.24 %) of recipients who received ATG (p [ 0.05). The incidence of CMV disease was similar in cyclosporine based regimen (13.2 %) and Tacrolimus based regimen 27 (16.16 %) (p = 0.137) and was also similar in Azathioprine 41 (9.5 %) and MMF group 33 (14.3 %) (p = 0.163). There was no significant difference in severity of CMV disease in both groups, except a higher incidence of leucopenia in Azathioprine group (86 vs. 74 %, p \ 0.05) as compared to MMF group. 51 (68.91 %) patient developed graft dysfunction during CMV disease. In conclusion we report a low incidence (14.2 %) and milder form of cytomegalovirus disease at our center. Use of universal cytomegalovirus prophylaxis was associated with a low incidence and milder form of the disease. Incidence of CMV disease was similar between Azathioprine and MMF groups.
Cytomegalovirus Infection in Kidney Transplant Recipients
2021
Introduction: Present study examined the frequency of CMV infection during follow-up using quantitative nucleic acid amplification testing, the frequency of administration of infection prophylaxis, viremia and infection in kidney transplant recipients who underwent transplantation (TX) at the University Hospital Center Osijek. Materials and Methods: 107 kidney recipients who underwent transplantation in the period 20 October 2007-24 August 2016 were included. Demographic and clinical data, data about pretransplantation CMV IgG test results of recipients and their donors, data about CMV prophylaxis, viremia, infection, and kidney transplant function were taken from medical records and analyzed. Results: 92.5% of kidney recipients and 86% of donors were CMV IgG positive before TX. 28% of recipients were CMV-DNA positive at some point after TX, none of whom received a transplant from an IgG negative donor. 89.7% of participants received CMV prophylaxis. Seven participants developed CMV disease, 2 of whom were not administered prophylaxis. Participants were tested for CMV-DNA once a year (median; min 0 max 6). CMV disease was marginally more frequent in those who did not receive valganciclovir prophylaxis (P = 0.066). Conclusion: It seems wise to enforce the administration of CMV prophylaxis and CMV-DNA testing in accordance with protocol, in order to detect viremia on time and to implement preemptive treatment, aiming at prevention of clinical manifestation of infection and preservation of graft function.