Hospitalizations for Cytomegalovirus Disease after Renal Transplantation in the United States

Abbott, Kevin C.; Hypolite, Iman O.; Viola, Rebecca A; Poropatich, Ronald K.; Hshieh, Paul; Cruess, David F.; Hawkes, Clifton A.; Agodoa, Lawrence Y.

doi:10.1016/s1047-2797(01)00283-6

Cited by 76 publications

(61 citation statements)

References 29 publications

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“…Farrugia and Schwab [11] identified fever, malaise, and myalgia as the most common symptoms. 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.…”

Section: Discussionmentioning

confidence: 92%

“…Though, some studies [6,17] have also shown higher, but not statistically significant percentage of leucopenia with Azathioprine use when compared to MMF (2 g/day) in patients who developed CMV disease in their cohort. Only higher dose of MMF (3 g/day) was associated with an increased incidence of leucopenia in patients who developed CMV disease when compared with Azathioprine [10,12,18].…”

Section: Discussionmentioning

confidence: 94%

“…Other risk factors for CMV disease include graft rejection and increased levels of immunosuppressive therapy, including anti-lymphocyte therapy, high dose corticosteroids, and Mycophenolate mofetil (MMF) [9][10][11]. Severe graft rejection and increased immunosuppression may cooperatively stimulate the development of active CMV infection in renal transplant recipients and CMV may activate the immune response to the graft [12].…”

Section: Introductionmentioning

confidence: 99%

“…CMV disease is an independent risk factor for acute rejection within the first 100 days and for recipient mortality [12]. In addition, the incidence of diabetes mellitus is higher in renal transplant recipients who developed CMV disease [5].…”

Section: Introductionmentioning

confidence: 99%

“…Some studies have shown a slight increase in incidence and tissue invasive disease in patients being treated with MMF of 2 or 3 g/day compared with placebo or Azathioprine [2,[8][9][10]12]. There is paucity of data regarding CMV disease in renal transplant recipients in Indian subcontinent.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 92%