Fatal cytomegalovirus disease in a high-risk renal transplant recipient

Abstract

The incidence of CMV infection in pediatric renal transplant recipients has increased as immunosuppression levels deepen following the use of newer immunosuppressive agents. It has been thought that 3-5 months of anti-CMV prophylaxis offers sufficient protection for these patients. We present a case of late-onset fatal CMV disease in a pediatric renal transplant recipient who received prolonged anti-CMV prophylaxis while on "quadruple" immunosuppression with daclizumab, mycophenolate, tacrolimus, and prednisone. Our case has prompted us to reassess CMV surveillance, prophylaxis, and immunosuppression levels in our pediatric renal transplant patients.

Posttransplant Viral Syndromes in Pediatric Patients: A Review

“…Risk factors for the development of CMV infection are well described. [11][12][13] CMV-negative patients who receive a CMV-positive allograft are at risk for primary infection and graft invasion. Significant morbidity and mortality associated with graft loss exist in this high-risk group of patients.…”

“…1 The relationship of CMV to acute and chronic allograft injury and rejection is complex and the subject of extensive research in all solid organ transplant populations. [11][12][13] In kidney transplantation, CMV causes a particular type of allograft injury that makes it difficult to distinguish from injury caused by rejection. 13 CMV is associated with vascular rejection and coronary artery disease in cardiac allografts, obliterative bronchiolitis in lung transplant recipients, and obliterative arteriopathy and bile ductopenia in liver allografts.…”

“…13 CMV is associated with vascular rejection and coronary artery disease in cardiac allografts, obliterative bronchiolitis in lung transplant recipients, and obliterative arteriopathy and bile ductopenia in liver allografts. [11][12][13][14] CMV-positive donor organs Blood, body fluids…”