Cytomegalovirus Pneumonia Ten Years After Renal Transplant–A Manifestation Of Sustained Lymphocyte Depletion (original) (raw)
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Cytomegalovirus pneumonia in renal transplant patients
Transplantation Proceedings, 1998
C YTOMEGALOVIRUS(CMV) pneumonia has been a common cause of mortality in renal transplant recipients with a reported fatality rate of 48% and Ͼ90% in ventilator-assisted patients, although it has been noted to be more frequent and more severe in cardiac transplant patients than in other solid organ recipients. Its role in renal allograft dysfunction is also well established. 1-3 Diagnosis, however, is often obscured or not recognized because of the presence of overlapping clinical presentation. Other investigators suggest that demonstration of CMV in those cases indicates only colonization and not infection. Chest radiography may not even show a typical interstitial pattern of viral pneumonia. 1,4,5 Furthermore, insensitive techniques and absence of uniform criteria for determining the presence of CMV pneumonia make diagnosis difficult. This study describes the clinical features and outcome of CMV pneumonia in renal allograft recipients at the National Kidney and Transplant Institute. General Objectives *One (1) patient with acute rejection therapy. † All patients with acute rejection therapy.
Signs and Symptoms of Cytomegalovirus Disease in Kidney Transplant Recipients
Transplantation Proceedings, 2005
Purpose. To investigate the range of clinical presentations of cytomegalovirus (CMV) disease in kidney transplant recipients. Materials and methods. We retrospectively reviewed the records of hundred kidney recipients who developed CMV disease between 1984 and December 2002 for demographic characteristics, laboratory findings, and presenting signs and symptoms. Results. The most common presentations were elevated serum creatinine in 74 patients, fever in 71, thrombocytopenia in 43, nausea in 32, vomiting in 25, elevated alkaline phosphatase in 24, leukocytosis in 22, and leukopenia in 21. Tissue involvement was relatively rare, but six patients had pneumonia, two had conjunctivitis, and one had vascular dermatitis. Four percent of the patients had received intravenous ganciclovir prophylaxis, and 7% had received oral ganciclovir prophylaxis. Fever was associated with number of hospitalizations (P ϭ .006), elevated creatinine (P ϭ .006), nausea (P ϭ .017), vomiting (P ϭ .031), and previous posttransplantation infections (P Ͻ .001). All the patients with conjunctivitis, pneumonia, pulmonary symptoms, and abnormal heart sounds and most of those with arthralgia, nausea, and vomiting were febrile during their CMV disease course. Conclusion. Our findings showed that leukocytosis should be considered as much as leukopenia when CMV disease is suspected. CMV-induced pneumonia is not common in renal transplant recipients compared to other organ transplant recipients. CMV invasion to other tissues is also rare. Finally, fever is a common symptom and important in assessing the severity and prognosis of the disease.
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 Following Renal Transplantation – an Overview
Apollo Medicine, 2008
CMV infection is an important concern after renal transplantation. Since it may cause acute rejection and graft loss. Advances in laboratory methods (e.g., molecular amplification techniques) and availability of effective therapeutic agents (ganciclovir foscarnet) have provided effective management of CMV infection.
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.
Prevalence of cytomegalovirus disease in kidney transplant patients in an intensive care unit
Revista Brasileira de terapia intensiva
To define the frequency of cytomegalovirus disease among kidney transplant patients in an intensive care unit in which this complication was suspected and to identify predisposing factors and their possible impact on clinical outcome. Retrospective observational study in which kidney transplant patients over the age of 18 years were hospitalized for any reason in an intensive care unit with at least one collection of samples to test for the presence of antigenemia or cytomegalovirus via polymerase chain reaction during hospitalization. Cytomegalovirus disease was defined as positive antigenemia or polymerase chain reaction above 500 copies/mL in the presence of symptoms and in the appropriate clinical setting, as judged by the attending physician. A total of 99 patients were included (age: 53.4 ± 12.8 years, 71.6% male). Cytomegalovirus disease was diagnosed in 39 patients (39.4%). Respiratory symptoms (51%), non-specific clinical worsening (20%) or gastrointestinal symptoms (14%) w...
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,