Cytomegalovirus Disease in Renal Transplant Recipients: A Single-Center Experience

Abstract

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.

Gastrointestinal complications after kidney transplantation

“…Gastrointestinal complications in kidney transplant reci-pients may be a consequence of typical infections occurring in transplant recipients, such as cytomegalovirus (CMV) infection[ 7 - 10 ], and of immunosuppression-mediated injury to the gastrointestinal mucosa. Post-transplant inflammatory bowel disease (IBD) may arise from an inappropriate immune response to intestinal antigens resulting in continuous intestinal inflammation[ 5 ].…”

Clinical relevance of the plasma load of cytomegalovirus in patients infected with HIV—A survival analysis

“…Infection with cytomegalovirus (CMV) is still a major concern in immunosuppressed patients, especially in transplant recipients, many studies highlighting the clinical utility of CMV viraemia to monitor them and guide their therapy [Li et al, 2007;Bhadauria et al, 2012;Manuel, 2013;Ramanan and Razonable, 2013;Razonable and Hayden, 2013;Ariza-Heredia et al, 2014;Florescu et al, 2014]. Although the rate of CMV disease among patients infected with HIV has decreased significantly over the past 20 years under combination antiretroviral therapy (cART) [Palella et al, 1998;Crumpacker and Zhang, 2010], episodes of acute CMV infection or reactivation still occur in these patients.…”

Cytomegalovirus Infection in Pediatric Renal Transplant Recipients: A Single Center Experience

“…In previous studies, the median time interval ranged from 5.0 months Abbreviations: CMV, cytomegalovirus; KT, kidney transplantation. to 9.4 months [13][14][15] . The median time interval between the transplantation and the CMV infection was 4.0 months in our study, which is shorter to previous studies.…”