Clinical correlates of pp65 antigenemia monitoring in the first months of post kidney transplant in patients undergoing universal prophylaxis or preemptive therapy

Carvalho, Fabiana Rabe; Cosendey, Rachel Ingrid Juliboni; Souza, Cintia Fernandes; Medeiros, Thalia; Menezes, Paulo; Silva, Andréa Alice; Almeida, Jorge Reis; Lugon, Jocemir Ronaldo

doi:10.1016/j.bjid.2016.09.016

Cited by 4 publications

(10 citation statements)

References 31 publications

(36 reference statements)

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“…In bone marrow transplanted patients, a single positive cell is enough to be considered as a positive result33. Therefore, routine CMV monitoring in transplantation can be used as a preemptive approach, so that pp65 antigenemia might work as a marker of infection or viral replication, as performed in our group31. In 2013, a study10 reported a cutoff value of 10 cells per 200,000 leukocytes to associate CMV with mortality in autoimmune diseases ( 75% sensitivity and 72.2% specificity).…”

Section: Discussionmentioning

confidence: 89%

“…CMV viremia is very prevalent among immunosuppressed patients, and various diagnostic strategies have been commonly used in clinical practice, for example PCR and pp65 antigenemia. Some transplantation centers monitor antigenemia closely, and to prevent CMV complications phisicians start promptly preemptive and /or prophylactic treatment, mostly in the first six months after transplantation31. However, data about CMV monitoring in autoimmune diseases are scarce, as well as protocols about when and how to monitor CMV infection in these autoimmune patients.…”

Section: Discussionmentioning

confidence: 99%

“…A small sample of peripheral blood is needed, and the test has a relatively low cost (compared with PCR) and high specificity30. The test allows repeating the CMV replication as many times as needed throughout the clinical investigation and monitoring treatment results through variations in viral replication, which is comparable to the tracking used in organ transplanted patients31. On the other hand, the validity of pp65 antigenemia as a diagnostic tool for patients with SLE presents some aspects that need to be discussed further.…”

Section: Discussionmentioning

confidence: 99%

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Pp65 antigenemia and cytomegalovirus diagnosis in patients with lupus nephritis: report of a series.

et al. 2018

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pp65 antigenemia and cytomegalovirus diagnosis in patients with lupus nephritis: report of a series.

et al. 2018

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“…(Figure S1). In patients receiving prophylaxis (5 studies), reported rates of CMV infection during the first year post‐SOT were 5.2%, 30 26.0%, 24 45.4%, 31 50.0%, 22 and 50.2% 32 . According to studies conducted in Brazil, India, and South Korea, infection typically appeared after a median of 1–2 months postkidney or postliver transplantation 8,21,25,27,29,32–39 .…”

Section: Resultsmentioning

confidence: 99%

Epidemiology, management, and burden of cytomegalovirus in solid organ transplant recipients in selected countries outside of Europe and North America: A systematic review

Silva

Tokat

Cai

et al. 2023

Transplant Infectious Dis

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BackgroundCytomegalovirus (CMV) is a frequent infectious complication following solid organ transplantation (SOT). Considering significant differences in healthcare systems, a systematic review was conducted to describe the epidemiology, management, and burden of CMV post‐SOT in selected countries outside of Europe and North America.MethodsMEDLINE, Embase, and Cochrane databases were searched for observational studies in SOT recipients across 15 countries in the regions of Asia, Pacific, and Latin America (search period: January 1, 2011 to September 17, 2021). Outcomes included incidence of CMV infection/disease, recurrence, risk factors, CMV‐related mortality, treatment patterns and guidelines, refractory and/or resistant CMV, patient‐reported outcomes, and economic burden.ResultsOf 2708 studies identified, 49 were eligible (n = 43/49; 87.8% in adults; n = 34/49, 69.4% in kidney recipients). Across studies, selection of CMV preventive strategy was based on CMV serostatus. Overall, rates of CMV infection (within 1 year) and CMV disease post‐SOT were respectively, 10.3%–63.2% (9 studies) and 0%–19.0% (17 studies). Recurrence occurred in 35.4%–41.0% cases (3 studies) and up to 5.3% recipients died of CMV‐associated causes (11 studies). Conventional treatments for CMV infection/disease included ganciclovir (GCV) or valganciclovir. Up to 4.4% patients were resistant to treatment (3 studies); no studies reported on refractory CMV. Treatment‐related adverse events with GCV included neutropenia (2%–29%), anemia (13%–48%), leukopenia (11%–37%), and thrombocytopenia (13%–24%). Data on economic burden were scarce. imageConclusionOutside of North America and Europe, rates of CMV infection/disease post‐SOT are highly variable and CMV recurrence is frequent. CMV resistance and treatment‐associated adverse events, including myelosuppression, highlight unmet needs with conventional therapy.

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“…The recipient received thymoglobulin as induction therapy and was maintained on prednisone, mycophenolate sodium, and tacrolimus. She underwent universal prophylaxis for CMV infection with intravenous ganciclovir (5 mg/kg) 5 days after transplant, according to the institutional protocol: 10 twice a day (week 1 and week 2 post-transplant, PT); three times a week (week 3 and week 4 PT); twice a week (week 5 up to week 8 PT), once a week (week 9 up to week 12 PT). The dose of ganciclovir was adjusted for the patient's renal function.…”

Section: Introductionmentioning

confidence: 99%

Hemophagocytic lymphohistiocytosis, a rare condition in renal transplant - a case report

et al. 2018

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Hemophagocytic lymphohistiocytosis (HLH) is an uncommon and life-threating condition characterized by major immune activation and massive cytokine production by mononuclear inflammatory cells, due to defects in cytotoxic lymphocyte function. It is even more unusual in renal transplant recipients, in which it is often associated with uncontrolled infection. The mortality is high in HLH and differential diagnosis with sepsis is a challenge. The approach and management depend on the underlying trigger and comorbidities. We report a case of a 50-year-old renal transplant female admitted with fever and malaise 3 months post-transplant and presenting anemia, fever, hypertriglyceridemia, high levels of serum ferritin, and positive CMV antigenemia. Urine was positive for decoy cells and BKV-DNA. Graft biopsy showed CMV nephritis. Both blood and urine cultures where positive for E. coli. Hemophagocytosis was confirmed by bone marrow aspiration. Immunosuppression was reduced, and the patient received high-dose intravenous immunoglobulin and dexamethasone, with complete response after 3 weeks. We highlight the importance of early diagnosis and proper management of a rare and serious condition in a renal transplant patient, which can allow a favorable clinical course and improve survival rate.

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Clinical correlates of pp65 antigenemia monitoring in the first months of post kidney transplant in patients undergoing universal prophylaxis or preemptive therapy

Cited by 4 publications

References 31 publications

Pp65 antigenemia and cytomegalovirus diagnosis in patients with lupus nephritis: report of a series.

Pp65 antigenemia and cytomegalovirus diagnosis in patients with lupus nephritis: report of a series.

Epidemiology, management, and burden of cytomegalovirus in solid organ transplant recipients in selected countries outside of Europe and North America: A systematic review

Hemophagocytic lymphohistiocytosis, a rare condition in renal transplant - a case report

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