Cytomegaloviral infection in solid organ transplant recipients: preliminary report of one transplant center experience.

BACKGROUND: Despite advances in immunosuppressive therapy and post-transplantation care, antiviral prevention, and therapy, cytomegalovirus (CMV) infection remains the most common viral infection after solid organ transplantation (SOT). METHODS: This study included 2,375 patients under the care of our transplant center during the 1-year period from June 2012 to June 2013. There were 351 patients (14.78%) suspected and tested for CMV infection with the use of viral DNA amplification test. RESULTS: Symptoms that triggered diagnostics were graft dysfunction in 24 (55.8%), diarrhea in 18 (41.9%), fever in 15 (34.9%), leukopenia in 14 (32.6%), abdominal pain in 13 (30.2%), nausea in 7 (16.3%), cough in 6 (14%), and shivers in 2 (4.7%). Positive test results were obtained in 43 patients (12.3% of patients tested and 1.8% of the entire cohort). The group consisted of 17 women (39.5%) and 26 men (60.5%), 26 kidney (60.5%) and 17 liver (39.5%) transplant recipients, aged 49.3 years (SD 14.9). The initial viral load was median 8,093 (range: 4,232-219,180) copies/mL. The mean ganciclovir (GCV) treatment duration was 19.05 (SD 8.1) days. GCV doses ranged from 100 to 1,000 mg/d, mean 370.6 (SD 254.2) mg/d. Clinical resistance to treatment was diagnosed in 5 patients (11.6%). We found a positive correlation of GCV treatment duration with natural logarithm of initial CMV viremia (r = 0.56; P = .0002) and of time in months to CMV infection with mean cyclosporine level (r = -0.74; P = .04) and GCV dose (r = -0.34; P = .03). The duration of GCV therapy was positively influenced by CMV load and tacrolimus administration and negatively by patient's age and male sex. CONCLUSIONS: Appearance of any symptoms occurring after transplantation, even nonspecific, should lead to diagnostics for CMV infection. The duration of treatment depends on the severity of the infection expressed by CMV viremia. Clinical resistance to GCV is not frequent, but it is an important transplantologic problem.

How to choose a statin after kidney transplantation: case analyses.

Statins are effective to reduce total cholesterol and low-density lipoprotein fractions in a dose-dependent manner. Moreover, they have an excellent safety profile. Besides cholesterol-lowering properties, statins have additional actions described in the present case report. The diverse effects of these drugs means that many patients with different disease entities, such as cardiovascular diseases, can benefit from their effects. However, the problem of so called "class effect" remains controversial. The question whether each drug within the group is equivalent appears important, as long as statins must be taken long-term and as the therapy affects patient quality of life and survival. To address this question, we present two renal transplant recipients treated with statins. The induction of pharmacokinetic tolerance and damage to hepatic cells during administration of statins is discussed. Presented data suggest that the choice of statin should be based on individual patient requirements and adapted to the individual treatment response.

Posttransplant lymphoproliferative disorder of the lung in a renal transplant recipient treated successfully with surgery.

Posttransplant lymphoproliferative disorders (PTLDs) are a heterogeneous group of lymphoid diseases that occur after solid organ and bone marrow transplantation. Lung-located PTLD has been reported in recipients of the heart, cord blood stem cells, lungs, and bone marrow transplants, but only four cases were reported previously after kidney transplantation. Thoracic location of PTLD must be regarded as an especially dangerous complication. The pathogenesis, and clinical and histological features of PTLD remain poorly defined but predisposing risk factors are becoming better understood. Namely, Epstein-Barr virus (EBV) and immunosuppressive agents appear to be such risk factors. There has been marginal success in treating PTLD using a number of treatment modalities, including combination chemotherapy with anti-CD20 or high-dose chemotherapy with stem cell rescue. We report a renal allograft recipient transplanted in March 2000, diagnosed with EBV-associated and lung-located PTLD. His initial immunosuppression consisted of tacrolimus, azathioprine, and steroids. Azathioprine was withdrawn in September 2001. In November 2001 a high-resolution computed tomography scan revealed two round masses in the right lung. The patient underwent right thoracotomy and resection of the lower and middle lobe. The diagnosis of PTLD was settled by intraoperative histopathological evaluation. The postoperative histological assessment confirmed the diagnosis and revealed positive staining for EBV. The patient remained in complete remission for 3 years with a well-functioning renal allograft, with current serum creatinine of 1.2 mg%. This case illustrates that the treatment of lung-located PTLD may be successful, but it depends on a combination of prompt diagnosis, reduction of immunosuppression, and of course surgery.