Cytomegalovirus infection after orthotopic liver transplantation

Kim, S.J; Joh, Jae‐Won; Lee, S.K; Choi, Sooin; Park, Y.H; Kim, S.M; Peck, Kyong Ran; Song, Jae-Hoon; Kim, Y.I; Lee, B.B

doi:10.1016/s0041-1345(98)00972-5

Cited by 5 publications

(6 citation statements)

References 6 publications

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“…Similar to other chronic viral infections, such as those with cytomegalovirus and Epstein-Barr virus, infection of an individual with a second viral strain (dual infection) [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] occurs in HIV infection. The terminology related to dual infection is important.…”

Section: What Is Superinfection?mentioning

confidence: 99%

HIV Superinfection

2005

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Worldwide, 16 cases of HIV-1 superinfection in humans have been reported since 2002. Superinfection is defined as the reinfection of an individual who already has an established infection with a heterologous HIV strain. Controversy exists surrounding superinfection, because it has implications concerning our understanding of worldwide HIV diversity, individual immunity and disease progression, and vaccine development. Here, we review the current understanding of HIV superinfection.

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Section: What Is Superinfection?mentioning

confidence: 99%

HIV Superinfection

2005

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“…In our center, CMV infection is monitored by alternate‐day PCR testing, and preemptive therapy is instituted if 2 consecutive blood samples are positive. This treats infection early and prevents disease,15 and may explain the lack of correlation with CMV infection found in other studies 16, 17…”

Section: Discussionmentioning

confidence: 95%

Incidence and risk factors for the development of prolonged and severe intrahepatic cholestasis after liver transplantation

et al. 2006

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Predictive factors for intrahepatic cholestasis after orthotopic liver transplantation (OLT) have not yet been established. We sought to identify the incidence and risk factors associated with prolonged severe intrahepatic cholestasis (PSIC) after OLT. We assessed 428 consecutive patients undergoing their first OLT. PSIC was diagnosed if a serum bilirubin concentration was greater than 100 mol/L and/or a 3-fold increase of alkaline phosphatase occurred within the first month after OLT and was sustained for at least 1 week in the absence of biliary complications. Multivariable logistic regression identified factors independently associated with PSIC. PSIC developed in 107 patients (25%). Independent risk factors by multivariable analysis were intraoperative transfusion of cryoprecipitate and platelets; nonidentical blood group status; suboptimal organ appearance; inpatient status before transplantation; and bacteraemia in the first month after transplantation. In contrast, acute liver failure, older age, and higher levels of serum sodium and serum potassium were all associated with a reduced likelihood of developing PSIC in the first month. There were 47 deaths in the PSIC group (44%) as opposed to 65 deaths in the non-PSIC group (20%) after OLT. A poor preoperative clinical status in conjunction with a suboptimal graft was associated with PSIC after OLT. Avoidance of suboptimal livers and ABO nonidentical grafts for young patients with poor synthetic function and for pretransplant inpatients may lessen this complication and reduce the associated early mortality.

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“…Acyclovir protects against herpes simplex virus (HSV) in seropositive lung transplant recipients and partially against CMV infection in renal transplant recipients. Prophylactic treatment of CMV (ganciclovir) is indicated in seronegative liver recipients who get grafts from seropositive donors because of the high risk of primary infection, which is more severe than reactivated latent infection [16]. Seronegative kidney recipients are treated with polyclonal anti‐CMV immunoglobulin.…”

Section: Infections In Transplant Recipientsmentioning

confidence: 99%

“…General anti-inflammatory ment of CMV (ganciclovir) is indicated in seronegative liver recipients who get grafts from seropositive cellular effects include decreased capillary permeability, inhibition of histamine release, inhibition of donors because of the high risk of primary infection, which is more severe than reactivated latent intracellular adhesion, and stabilization of lysosomal membranes. Intravascular systems such as infection [16]. Seronegative kidney recipients are treated with polyclonal anti-CMV immunoglobulin.…”

Section: Molecular Mechanismsmentioning

confidence: 99%

Immunologic Aspects of Transplant Management: Pharmacotherapy and Rejection

Power

Rosenbloom

2000

J Intensive Care Med

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The intensivist caring for the critically ill transplant patient must be knowledgeable in the management of immunosuppression or have expert help. Critical illness often has a major impact on the absorption and metabolism of immunosuppressive drugs, increasing or decreasing net immunosuppression. Too little immunosuppression brings the risk of graft loss, while too much increases the morbidity and mortality of serious infection. Optimum management often requires the skillful manipulation of dosage and/or routes of drug delivery. In many cases of life‐threatening infection, immunosuppression must be discontinued altogether and restarted prior to significant graft injury. The cost of miscalculation is very high. Loss of a renal, pancreas, or small bowel transplant is tragic, while loss of a heart, lung, or liver is usually fatal. Unfortunately the management of immunosuppression is becoming more complex. As the field of transplantation matures, new immunosuppressants are being introduced. Also, more experience and growing numbers of clinical trials are making the required knowledge base ever larger. Each type of transplant has its own set of evolving immunosuppression strategies. This review presents the basic mechanisms of the most widely used drugs and the dangers of immunosuppression. The drugs are then discussed in the context of liver, small bowel, kidney, pancreas, heart, and lung transplantation. Finally, a brief section on the practical pharmacokinetics of the drugs is presented.

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Cytomegalovirus infection after orthotopic liver transplantation

Cited by 5 publications

References 6 publications

HIV Superinfection

HIV Superinfection

Incidence and risk factors for the development of prolonged and severe intrahepatic cholestasis after liver transplantation

Immunologic Aspects of Transplant Management: Pharmacotherapy and Rejection

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