Cytomegalovirus transmission in pediatric renal transplant recipients during the window period

Abstract

We report two CMV naïve children who received deceased donor renal transplants from a CMV IgG-negative single donor. CMV IgG in both recipients and the donor were negative immediately prior to transplant. Both recipients had early recurrences of their original disease in their transplants, requiring multiple sessions of plasmapheresis. All blood products used were leukoreduced or CMV seronegative. A few days post-transplant, both recipients developed significant positive CMV viremia. Both required initiation of oral valganciclovir. Case 1 responded to oral valganciclovir only while the case 2 had a delayed response to it and hence required intravenous ganciclovir with good response. When checked retrospectively, CMV IgM in the donor was positive along with positive CMV DNA PCR from the white cells. Here we describe a very unusual scenario of CMV transmission in two pediatric renal transplant recipients from a single donor during the CMV window period.

Persistent primary cytomegalovirus infection in a kidney transplant recipient: Multi-drug resistant and compartmentalized infection leading to graft loss

“…Considering that, the donor had CMV IgM and IgG, indicative of a recent primary infection with a possibly ongoing asymptomatic low viremia, the donor might have transmitted an active CMV infection to our patient. CMV transmission has been reported from a CMV IgM positive donor only a few days after transplantation (Gangopadhyay et al, 2016), similar to our patient (CMV PCR positive at day 29 post-transplantation).…”