Infection with cytomegalovirus (CMV) with resistance to ganciclovir (GCV) is a therapeutic challenge in kidney transplant patients, because standard treatment options are nephrotoxic. We report the case of a kidney transplant recipient with GCV-resistant CMV disease, in whom letermovir, a novel inhibitor of CMV packaging, was administered off-label and prevented a relapse of disease once the CMV load was decreased by cidofovir. Furthermore, we observed significant drug interactions between letermovir and tacrolimus.
Graft-versus-host disease (GVHD) is a potentially lethal complication commonly occurring after hematopoietic stem cell transplantation and non-irradiated blood cell transfusion in patients with underlying immunodeficiency. In solid organ transplantation GVHD however is a rarity. There have been four cases of GVHD after renal transplantation, most of them with fulminant systemic clinical manifestation and mostly associated with blood transfusions. We report the first case of a four HLA-antigen mismatched kidney transplant patient who presented with diarrhea due to intestine-only manifestation of GVHD and was treated successfully with quadruple immunosuppression.
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