Cytomegalovirus-associated venous thromboembolism in renal transplant recipients: A report of 7 cases

Abstract

Renal-transplant recipients have a higher prevalence of thromboembolic events compared with the general population. This elevated risk has been attributed to immunosuppressive drugs as well as metabolic and immunologic factors. Cytomegalovirus (CMV) infection, a frequent complication of transplantation, is known to modify endothelial phenotype from anticoagulant into procoagulant. There are few reports addressing the association of venous thromboembolism with CMV infection in immunocompetent patients. Some authors have also reported cases of arterial thrombosis in transplant recipients presenting CMV infection. However, the association of venous thromboembolic events with CMV infection has not yet been discussed in these patients. We present seven cases of simultaneous acute CMV infection and venous thromboembolism in renal-transplant recipients and suggest a potential causative effect.

Infection of Human Endothelium In Vitro by Cytomegalovirus Causes Enhanced Expression of Purinergic Receptors: A Potential Virus Escape Mechanism?

“…Such a response may thus promote immobilization, localization and subsequent removal of the virus. This is relatively frequently observed in subjects with CMV infection after renal transplantation (28,29).…”

Venous thromboembolism in hematopoietic stem cell transplant recipients

“…A 3.7% 1-year incidence of VTE, and 8-20% incidence of catheter-related thrombosis (CRT) have been reported in autologous stem cell transplant recipients. 12 HSCT recipients have several identifiable risk factors for thrombosis including malignancy, high-dose myeloablative chemotherapy and immune-modulatory drugs, [13][14][15][16] graft versus host disease (GVHD), [17][18][19] infections, 14,20 indwelling vascular catheters and prolonged immobilization. 14 HSCT is also associated with an 'acquired hypercoagulable state' characterized by inflammation, endothelial damage and activation of endothelium-dependent coagulation factors, increase in von Willebrand factor and platelet adhesion, increased thrombin generation, decreased anti-thrombin levels and decreased levels of anticoagulant proteins such as protein C. [21][22][23][24][25][26][27] graft versus host disease (GVHD) is associated with inflammation that leads to endothelial damage and activation.…”

The incidence of and risk factors for venous thromboembolism (VTE) and bleeding among 1514 patients undergoing hematopoietic stem cell transplantation: implications for VTE prevention

“…10 However, relatively little information is available regarding the risk of VTE and the optimal approach to VTE prevention among individuals undergoing hematopoietic stem cell transplantation (HSCT). 11 Patients undergoing HSCT have a number of identifiable risk factors for VTE, including prolonged hospitalization, indwelling vascular catheters, exposure to cytotoxic chemotherapy and immune modulators, [12][13][14][15][16] infections, 17 and graft-versus-host disease (GVHD). 18,19 However, perhaps even more so than other patients with hematologic malignancies, patients undergoing HSCT also face an increased risk of bleeding.…”