Cytomegalovirus and Kidney Transplantation: An Update

Abstract

Cytomegalovirus (CMV) infection is the most common infection affecting kidney transplant recipients [1]. CMV may be present as asymptomatic viremia or with symptoms ranging from mild to significant tissue-invasive disease [1-3]. Optimal kidney graft function and survival requires that transplant care teams carefully assess individual patient risk of CMV [2, 3]. Appropriate patient surveillance and prophylaxis are essential to ensure the best long-term kidney transplant results. Effective treatment of CMV disease requires a high degree of suspicion and appropriate diagnostic tests. The choice of antiviral medication and duration of treatment are important considerations to ensure optimal patient outcomes and kidney graft function and survival.

A Rare and Complex Case of Multifactorial Thrombotic Microangiopathy in A Kidney Transplant Recipient: Interplay Between Antibody Mediated Rejection, Tacrolimus Toxicity, Cytomegalovirus Disease and BNT162b2mRNA Vaccine

“…This former is supported by the fact that none of the patient's transplant biopsies showed viral cytopathic inclusion bodies or SV40 positivity, though other case reports suggest that this does not rule CMV out as a causative factor [5]. CMV can also have long term effects on the graft, from interstitial nephritis and renal artery stenosis to ureteric strictures, though again this did not seem to be a factor in our patient [17].…”

“…In our patient, recurrent CMV was a complication throughout her post-transplant course requiring careful balance of adequate immunosuppression, given known rejection risk, versus reducing ongoing infectious risk. A further risk factor for her was the initial ATG induction [17]. After the episode of CMV colitis, our patient had remained on valganciclovir prophylaxis.…”

“…In an immunocompromised host, reactivation manifests as CMV disease. This can either be tissue invasive disease (colitis, hepatitis, retinitis, nephritis, pneumonitis, encephalitis, oesophagitis, pancreatitis, myocarditis), or viraemia with fever and leukopaenia [5,17]. Like other causes of post-transplant TMA, CMV can cause damage to endothelial cells and therefore stimulate platelet activation [5].…”

Human cytomegalovirus‐related gastrointestinal disease after kidney transplantation: A systematic review

“…8 Prompt diagnosis, anti-viral therapy, and immunosuppression modification are key factors in disease management. 9,10 Nevertheless, such aggressive policy entails a significant risk of drug-induced toxicity and allograft rejection. 11,12 hCMV replication in solid-organ transplant recipients is also accompanied by profound immunomodulation that, eventually, increases the risk of allograft rejection.…”

“…Major determinants of post‐transplant hCMV disease are donor's and recipient's serostatus, 4 net state of immunosuppression, 5 administration of anti‐rejection protocols containing mammalian target of rapamycin inhibitors (mTORi), 6 universal anti‐viral prophylaxis, 7 and, to a lesser degree, concomitant Epstein‐Barr virus or Polyomavirus BK infection 8 . Prompt diagnosis, anti‐viral therapy, and immunosuppression modification are key factors in disease management 9,10 . Nevertheless, such aggressive policy entails a significant risk of drug‐induced toxicity and allograft rejection 11,12 .…”