Prevalence of citomegalovirus disease in kidney transplant patients in an intensive care unit

Abstract

ObjectivesTo define the frequency of cytomegalovirus disease among kidney transplant patients in an intensive care unit in which this complication was suspected and to identify predisposing factors and their possible impact on clinical outcome.MethodsRetrospective observational study in which kidney transplant patients over the age of 18 years were hospitalized for any reason in an intensive care unit with at least one collection of samples to test for the presence of antigenemia or cytomegalovirus via polymerase chain reaction during hospitalization. Cytomegalovirus disease was defined as positive antigenemia or polymerase chain reaction above 500 copies/mL in the presence of symptoms and in the appropriate clinical setting, as judged by the attending physician.ResultsA total of 99 patients were included (age: 53.4 ± 12.8 years, 71.6% male). Cytomegalovirus disease was diagnosed in 39 patients (39.4%). Respiratory symptoms (51%), non-specific clinical worsening (20%) or gastrointestinal symptoms (14%) were the main reasons for exam collection. Transplant time was lower in those with cytomegalovirus disease than in those without this diagnosis (6.5 months and 31.2 months, p = 0.001), along with pulse therapy in the last 6 months (41% and 16.9%, p = 0.008) and previous use of thymoglobulin in the last year (35.9% and 6.8%, p < 0.001). In the logistic regression model, only the transplant time and the use of thymoglobulin were associated with a higher frequency of cytomegalovirus. There was no difference in clinical evolution between patients with and without cytomegalovirus disease.ConclusionIn kidney transplant patients suspected of cytomegalovirus disease, the prevalence was high. Transplant time less than 6 months, and the use of thymoglobulin in the last year should increase the intensivist's suspicion for this complication.

Epidemiology, management, and burden of cytomegalovirus in solid organ transplant recipients in selected countries outside of Europe and North America: A systematic review

“…The highest proportion (4.4%) was found in a cohort of high‐risk patients (serostatus D+/R–) 8 . For these patients, foscarnet or cidofovir was the preferred treatment 59 . However, owing to restricted access to these anti‐CMV drugs in low to medium income countries, the use of high‐dose GCV was also reported in Thailand 18 .…”

“…Alternative treatments such as acyclovir and its prodrug valacyclovir were also used to prevent the occurrence of CMV in Australia, 7 Brazil, 9 China, 49 Colombia, 43 Mexico, 20 and South Korea 31 . In adult and pediatric SOT recipients who developed CMV disease, intravenous GCV was found to be the preferred treatment, 21,52,59 used for a duration ranging from 12 to 24 days 33,52,60 …”