Cytomegalovirus Infection—an Etiological Factor for Rejection? A Prospective Study in 242 Renal Transplant Patients

Pouteil‐Noble, Claire; Écochard, René; Landrivon, G.; Donia-Maged, Ashraf; Tardy, J.; Bosshard, S.; Colon, S; Bétuel, H; Aymard, M.; Touraine, Jean‐Louis

doi:10.1097/00007890-199304000-00032

Cited by 160 publications

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“…47 How viral infections are involved in the development of chronic allograft nephropathy is not yet understood. We, as many other authors, [4][5][6][7][8][9] have observed that the number of acute rejections in renal transplanted patients with infections is higher than in patients who do not undergo infections. The occurrence of acute rejections is known as a risk factor for development of chronic allograft nephropathy.…”

Section: Discussionsupporting

confidence: 51%

“…1 Active CMV infection is the most frequent infection in renal transplanted patients, 2,3 and it has been shown to be a risk factor for the occurrence of acute rejection episodes. [4][5][6][7][8][9] CMV infection induces activation and proliferation of B lymphocytes in mice as in humans. 10,11 In renal transplanted patients experiencing CMV infection, an early transient increase in peripheral B lymphocyte levels has been documented.…”

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confidence: 99%

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Acute rejection and graft survival in renal transplanted patients with viral diseases

et al. 2004

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Transplanted patients are susceptible to viral infections; thus, the aim of this study was to evaluate the features of acute rejections and the outcome of the renal graft in transplanted patients with herpes virus diseases. Renal biopsies from 30 renal transplanted patients undergoing early acute rejection (type IA and IB according to the Banff 97 classification) were evaluated. In total, 15 of these patients experienced cytomegalovirus (CMV) or Epstein-Barr virus disease within the first year following transplantation (group I) and 15 patients showed no evidence of viral infection (group II). No significant differences between the groups in terms of age, male/female ratio, living/cadaveric donor ratio, cold ischemia time, HLA A-B matching, pretransplant panel reactive antibody test, occurrence of post-transplant tubular necrosis, plasma levels of cyclosporin A and mean percent increase of serum creatinine at the time of the biopsy were observed. In group I biopsies, the mean number of interstitial plasma cells, as well as the mean number of CD79a-positive cells (B lymphocytes and plasma cells) was significantly higher than in group II (Po0.01 and o0.01, respectively). There was a positive correlation between the number of infections and the number of plasma cells (Po0.05). In transplanted patients, CMV can trigger the formation of anti-endothelial cell antibodies, which have been proposed to play a role in antibody-mediated rejections. We investigated whether a deposition of C4d, a marker of antibody-mediated reactions, was present in renal peritubular capillaries. In group I C4d deposition was found in five cases, while in group II it was not observed (Po0.05). In group I, 7/15 patients developed chronic allograft nephropathy vs 1/15 patients in group II (Po0.05). The estimated 1-, 5-and 8-year cumulative graft survival rates were 80, 66 and 57%, respectively, in group I, while in group II the estimated 8-year cumulative survival rate was 100% (Po0.05). In conclusion, acute rejection biopsies of patients with viral infections displayed plasma cell infiltrates and, in several cases, C4d deposition. Our study suggests a role of B lymphocytes in the pathology of these rejections and confirms the association between viral infections and poor graft survival.

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Section: Discussionsupporting

confidence: 51%

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confidence: 99%

Acute rejection and graft survival in renal transplanted patients with viral diseases

et al. 2004

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“…About one-quarter of renal transplant recipients developed CMV disease [3]. Generally, the highest incidence of CMV disease occurs during the first 3 months post-transplant [4], and is most severe in CMV naïve (CMV seronegative) recipients who receive an organ from a CMV seropositive donor (D?/R-) [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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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.

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“…However, long-term graft survival is not improved to the same extent and chronic allograft nephropathy (CAN) has emerged as a leading cause of graft loss, in addition to death with functioning graft. Various factors, such as prolonged cold ischemia time and reperfusion injury, and also viral infection, are believed to contribute to the process of CAN [1,2]. However, a recent study by Nankivell et al has shown explicitly that the vast majority of renal grafts afflicted with CAN display lesions that may be associated with drug-induced nephrotoxicity, as a result of treatment with cyclosporin A (CsA) and tacrolimus [3,4].…”

Section: Introductionmentioning

confidence: 99%

Differential expression of tissue factor (TF) in calcineurin inhibitor-induced nephrotoxicity and rejection—implications for development of a possible diagnostic marker

Österholm

Veress

Simanaitis

et al. 2005

Transplant Immunology

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(word count 381)Deposition of fibrin in the form of fibrinoid necrosis is a common feature of severe acute renal allograft rejection. The role of the coagulation system and its initiator tissue factor (TF) during this process is, however, still poorly understood. In this study, we analyzed the expression of TF in 88 renal transplants afflicted with different forms of rejection and calcineurin inhibitor-induced nephrotoxicity, to see whether there was differential expression

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Cytomegalovirus Infection—an Etiological Factor for Rejection? A Prospective Study in 242 Renal Transplant Patients

Cited by 160 publications

References 0 publications

Acute rejection and graft survival in renal transplanted patients with viral diseases

Acute rejection and graft survival in renal transplanted patients with viral diseases

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

Differential expression of tissue factor (TF) in calcineurin inhibitor-induced nephrotoxicity and rejection—implications for development of a possible diagnostic marker

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