Clinical manifestations and diagnosis of cytomegalovirus infection in renal allograft recipients

Durlik, M.; Siennicka, Joanna; Litwińska, B; Majchrzak, Jadwiga; Trzcińska, Agnieszka; Samsel, Radosław; Lewandowska, Dorota; Chmura, A.; Pączek, Leszek; Lao, M; Kańtoch, M; Rowińskí, W

doi:10.1016/s0041-1345(00)02403-9

Cited by 8 publications

(8 citation statements)

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“…[11] In the study of Durlik et al, the incidence of hepatitis, gastroenteritis, and pneumonitis was 46%, 27%, and 9%, respectively. [12] In our study, the most commonly involved organs are the stomach, lung, and colon. CMV gastritis is seen in four recipients (13.8%), pneumonia in two (6.9%), and colitis in one (3.4%).…”

Section: Discussionmentioning

confidence: 72%

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

et al. 2008

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Section: Discussionmentioning

confidence: 72%

“…[6,12] Leukocytosis is as important as leukopenia in the diagnosis of the disease. In our study, the incidence of leukopenia and leukocytosis was 34.5% and 20.7%, respectively.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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“…In the study of Abbott et al [12], pneumonia was seen in 17.1 %, hepatitis in 4.2 %, and complications of transplanted organ in 6.6 % of renal transplant recipients hospitalized for CMV disease. In the study of Durlik et al [14], the incidence of hepatitis, gastroenteritis, and pneumonitis was 46, 27, and 9 %, respectively. In our study, the most commonly involved organs were also the stomach, lung, and colon.…”

Section: Discussionmentioning

confidence: 92%

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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“…The association between transplantation time and CMV disease may be explained by the higher immunosuppressive load in the period closest to transplantation. ( 4 , 5 , 7 , 25 , 26 ) We also showed that hospital mortality of critical kidney transplant patients with clinical suspicion of CMV disease was high, regardless of the laboratory evidence of this infection. This high mortality may be a consequence of the high complexity of the population admitted to the ICU, as seen by the severity scores used.…”

Section: Discussionmentioning

confidence: 52%

“…Cytomegalovirus disease is a complication with high prevalence among kidney transplant patients, ( 3 - 7 ) although there is great variation among published studies, with oscillations ranging from 5.8% to 100%. ( 4 - 7 ) There are several reasons for this variation, but the types of populations studied and the immunosuppression ( 8 ) and diagnostic test used ( 7 ) are among the main reasons. Reports have shown that, in patients admitted to hospitals, the prevalence rates of infection ranged from 13.3% to 39.2%, ( 3 , 6 , 9 - 11 ) while a study conducted in outpatients showed a prevalence of 5.8%.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of citomegalovirus disease in kidney transplant patients in an intensive care unit

Santos¹,

Bafi²,

Freitas³

et al. 2017

Revista Brasileira De Terapia Intensiva

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ObjectivesTo define the frequency of cytomegalovirus disease among kidney transplant patients in an intensive care unit in which this complication was suspected and to identify predisposing factors and their possible impact on clinical outcome.MethodsRetrospective observational study in which kidney transplant patients over the age of 18 years were hospitalized for any reason in an intensive care unit with at least one collection of samples to test for the presence of antigenemia or cytomegalovirus via polymerase chain reaction during hospitalization. Cytomegalovirus disease was defined as positive antigenemia or polymerase chain reaction above 500 copies/mL in the presence of symptoms and in the appropriate clinical setting, as judged by the attending physician.ResultsA total of 99 patients were included (age: 53.4 ± 12.8 years, 71.6% male). Cytomegalovirus disease was diagnosed in 39 patients (39.4%). Respiratory symptoms (51%), non-specific clinical worsening (20%) or gastrointestinal symptoms (14%) were the main reasons for exam collection. Transplant time was lower in those with cytomegalovirus disease than in those without this diagnosis (6.5 months and 31.2 months, p = 0.001), along with pulse therapy in the last 6 months (41% and 16.9%, p = 0.008) and previous use of thymoglobulin in the last year (35.9% and 6.8%, p < 0.001). In the logistic regression model, only the transplant time and the use of thymoglobulin were associated with a higher frequency of cytomegalovirus. There was no difference in clinical evolution between patients with and without cytomegalovirus disease.ConclusionIn kidney transplant patients suspected of cytomegalovirus disease, the prevalence was high. Transplant time less than 6 months, and the use of thymoglobulin in the last year should increase the intensivist's suspicion for this complication.

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Clinical manifestations and diagnosis of cytomegalovirus infection in renal allograft recipients

Cited by 8 publications

References 11 publications

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

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

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

Prevalence of citomegalovirus disease in kidney transplant patients in an intensive care unit

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