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Roy S, Kaul A, Bhadhuria DS, Prasad N, Garg A, Marak RSK, Patel MR, Behera MR, Kushwaha RS, Yachha M. Clinico-epidemiological characteristics of early- versus late-onset cytomegalovirus disease among renal transplant recipients: A two-decade experience. Transpl Immunol 2024; 84:102040. [PMID: 38565378 DOI: 10.1016/j.trim.2024.102040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Reactivation of cytomegalovirus (CMV) infection in transplant patients is high because of immunosuppression. We have evaluated the clinical and epidemiological characteristics of early versus late onset of CMV infection among renal transplant recipients. METHODS A single center retrospective observational study was conducted among renal transplant recipients who underwent kidney transplant between January 2002 and December 2021. CMV disease was classified as early or late depending on its detection prior to or after 90 days post-transplantation. Herein, we reported the differences between early and late onset of CMV disease with respect to clinical symptoms, the use of immunosuppression and the impact on graft outcomes. RESULTS Out of total 2164 renal transplant recipients, 156 patients (7.2%) were diagnosed with CMV disease. Among these 156 patients, 25 patients (16%) had early CMV while 131 patients (84%) had late CMV. Overall, the two groups did not differ with respect to the induction or maintenance of immunosuppressive agents. However, the proportion of CMV syndrome was greater among early (56.0%) than late (26.7%) CMV groups (p = 0.01). In contrast, tissue invasive disease was more frequent among late (73.3%) in comparison to early (44.0%) CMV groups (p = 0.01). Among clinical symptoms, diarrhea was more frequent in late (63.4%) vs. early (36%) CMV-affected patients (p = 0.01). Graft loss occurred in 4.0% of early CMV group vs. 25.2% of late CMV group (p = 0.03). Neither of the clinical groups differed with respect to occurrence of biopsy-proven allograft rejection post-infection. CONCLUSIONS Early CMV disease presents more frequently as CMV syndrome while late CMV disease usually manifests itself as tissue invasive disease. Graft loss is more common in patients with late onset of CMV disease.
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Affiliation(s)
- Shuvam Roy
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anupma Kaul
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
| | - Dharmendra Singh Bhadhuria
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Narayan Prasad
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Atul Garg
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Rungmei S K Marak
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Manas Ranjan Patel
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Manas Ranjan Behera
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ravi Shankar Kushwaha
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Monika Yachha
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Massicotte-Azarniouch D, Detwiler RK, Hu Y, Falk RJ, Saha MK, van Duin D, Hogan SL, Derebail VK. Infections Following Kidney Transplantation After Exposure to Immunosuppression for Treatment of Glomerulonephritis. Am J Kidney Dis 2024; 83:784-793.e1. [PMID: 38160700 DOI: 10.1053/j.ajkd.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 10/10/2023] [Accepted: 10/24/2023] [Indexed: 01/03/2024]
Abstract
RATIONALE & OBJECTIVE Kidney transplant patients with glomerulonephritis (GN) as their native disease commonly have received pretransplant immunosuppression (PTI). This may contribute to the immunosuppression burden potentially increasing the risk for infections after transplantation. STUDY DESIGN Single-center, retrospective cohort study. SETTING & PARTICIPANTS Recipients of a kidney transplant from January 2005 until May 2020 at a tertiary care university teaching hospital. EXPOSURE Patients with GN as their native kidney disease who received PTI for treatment of GN (n=184) were compared with nondiabetic recipients of kidney transplants who did not receive PTI (n = 579). OUTCOME First occurrence after transplantation of an infection outcome, either viral (BK or cytomegalovirus [CMV] infection) or bacterial. ANALYTICAL APPROACH Cox regression analysis adjusted for age at transplant, sex, race, donor type, year of transplant surgery, dialysis vintage, receipt of T-cell depleting induction, and CMV transplant status. RESULTS Over a median follow-up period of 5.7 years, patients with GN PTI were not at an increased risk for developing any first viral infection compared with controls (adjusted HR [AHR] 0.69 [95% CI, 0.52-0.91]) nor at increased risk for specific viral infections: BK infection 19.6% vs 26.3% (AHR 0.72 [95% CI, 0.50-1.05]) or CMV infection, 24.5% vs 29.0% (AHR, 0.76 [95% CI, 0.54-1.07]), respectively. There was also no increased risk of developing a first bacterial infection: 54.5% vs 57.5% (AHR, 0.90 [95% CI, 0.71-1.13]). These findings of no increased risk for infection were independent of the type of PTI used (cyclophosphamide, rituximab, mycophenolate mofetil, or calcineurin inhibitor) or the type of T-cell depleting induction therapy (alemtuzumab or antithymocyte globulin) administered. LIMITATIONS Single-center study, no data on methylprednisone use for PTI, unmeasured confounding. CONCLUSIONS Use of PTI for the treatment of GN was not associated with an increased risk of viral (BK or CMV) or bacterial infection after transplantation. Additional surveillance for infection after transplantation for patients who received PTI may not be necessary. PLAIN-LANGUAGE SUMMARY Many kidney transplant patients have glomerular disease as the cause of kidney failure. These patients may be exposed to immunosuppression before transplantation, which could increase the risk for infections after receipt of a transplanted kidney. We identified kidney transplant recipients at a university teaching hospital who received immunosuppression before transplant for the treatment of glomerular kidney disease. We examined their risk for infection after transplantation by comparing it with the risk among transplant patients who were not exposed to immunosuppression before transplant. We observed no increased risk for infection after exposure to prior immunosuppression. Therefore, patients exposed to significant amounts of immunosuppression before transplantation may not require special surveillance or medication adjustment for fear of infection after their receipt of a kidney transplant.
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Affiliation(s)
- David Massicotte-Azarniouch
- UNC Kidney Center, Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Nephrology, Department of Medicine, University of Ottawa, Ontario, Canada.
| | - Randal K Detwiler
- UNC Kidney Center, Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yichun Hu
- UNC Kidney Center, Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ronald J Falk
- UNC Kidney Center, Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Manish K Saha
- UNC Kidney Center, Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - David van Duin
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Susan L Hogan
- UNC Kidney Center, Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Vimal K Derebail
- UNC Kidney Center, Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Kwon OK, Jeong ES, Lee KW, Choi MR, Sonn CH, Cho B, Shim J, Choi K, Kim SJ, Park JB. Monitoring Porcine Cytomegalovirus in Both Donors and Recipients is Crucial for Recipient's Survival in Pig-to-Cynomolgus Xenotransplantation. Transplant Proc 2024; 56:686-691. [PMID: 38378341 DOI: 10.1016/j.transproceed.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/16/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Xenotransplantation, particularly when involving pig donors, presents challenges related to the transmission of porcine cytomegalovirus (pCMV) and its potential impact on recipient outcomes. This study aimed to investigate the relationship between pCMV positivity in both donors and recipients and the survival time of cynomolgus monkey recipients after xenogeneic kidney transplantation. METHODS We conducted 20 cynomolgus xenotransplants using 18 transgenic pigs. On the surgery day, donor pig blood was sampled, and DNA was extracted from serum and peripheral blood mononuclear cells. Recipient DNA extraction followed the same protocol from pre-transplantation to post-transplantation. Porcine cytomegalovirus detection used real-time polymerase chain reaction (real-time PCR) with the ViroReal kit, achieving a sensitivity of 50 copies/reaction. A Ct value of 37.0 was the pCMV positivity threshold. RESULTS Of 20 cynomolgus recipients, when donors tested negative for pCMV, recipients also showed negative results in 9 cases. In 4 cases where donors were negative, recipients tested positive. All 5 cases with pCMV-positive donors resulted in positive assessments for recipients. Detection of donor pCMV correlated with shorter recipient survival. Continuous recipient positivity during observation correlated with shorter survival, whereas transient detection showed no significant change in survival rates. However, donor pig phenotypes and transplantation protocols did not significantly impact survival. CONCLUSION The detection of pCMV in both donors and recipients plays a crucial role in xenotransplantation outcomes. These findings suggest the importance of monitoring and managing pCMV in xenotransplantation to enhance long-term outcomes.
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Affiliation(s)
- O Kyung Kwon
- Transplantation Research Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Health Sciences & Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Eun Sung Jeong
- Department of Surgery, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Goyang, Republic of Korea
| | - Kyo Won Lee
- Transplantation Research Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Mi Ran Choi
- Transplantation Research Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Health Sciences & Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Chung Hee Sonn
- Transplantation Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Bumrae Cho
- GenNBio Co, Ltd, 80, Dreamsandan 2-ro, Cheongbuk-eup, Pyeongtaek-si, Gyeonggi-do, Republic of Korea
| | - Joohyun Shim
- Optipharm Inc., Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Kimyung Choi
- Optipharm Inc., Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Sung Joo Kim
- GenNBio Co, Ltd, 80, Dreamsandan 2-ro, Cheongbuk-eup, Pyeongtaek-si, Gyeonggi-do, Republic of Korea
| | - Jae Berm Park
- Transplantation Research Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Health Sciences & Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Republic of Korea; Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Montero C, Yomayusa N, Torres R, Cortes J, Alvarez C, Gallo J, Aldana G, Acevedo A, Rios M, Echeverri J, Yepes Z, Silva A, Gayon D, Perez J, Ibanez M. Low dose thymoglobulin versus basiliximab in cytomegalovirus positive kidney transplant recipients: Effectiveness of preemptive cytomegalovirus modified strategy. Nefrologia 2022:S2013-2514(22)00143-2. [PMID: 36437203 DOI: 10.1016/j.nefroe.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 10/06/2021] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND We performed a retrospective trial to determine asymptomatic CMV reactivation and CMV disease in kidney allograft recipients with positive CMV serostatus. METHODS Preemptive modified strategy under low dose thymoglobulin versus basiliximab induction was evaluated. Patients were monitored by CMV-polymerase chain reaction (PCR); if the viral load was >4000copies/μl, they received valganciclovir adjusted for their renal function. RESULTS 132 recipients were included in the study, 84 and 48 receiving basiliximab and thymoglobulin induction respectively, and followed up for 12 months. Asymptomatic CMV reactivation was significantly higher for thymoglobulin (77.1% vs. 16.7%, p<0.001). Treatment groups had similar rates of CMV disease (3.6% vs. 2.1%, p 0.538). The significant difference in asymptomatic CMV reactivation between two treatment groups did not have any impact on 1 year graft function (71±26ml/min vs. 74±19ml/min; p=0.475) and no histological differences in protocol biopsies were observed among patients with asymptomatic CMV reactivation vs those without CMV reactivation. CONCLUSIONS Due to the high asymptomatic CMV reactivation incidence in patients who received thymoglobulin induction, our results suggest that valganciclovir prophylaxis may be advantageous in CMV seropositive renal transplant recipients after low dose thymoglobulin induction. A preemptive strategy appeared to significantly reduce the likelihood of CMV disease in both groups. Rejection risk and negative impact in renal function associated with asymptomatic CMV reactivation was not found in our series.
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Affiliation(s)
- Camilo Montero
- Renal Transplantation Group, Clinica Reina Sofia, University Clinic, Bogota, Colombia; Translational Investigation Group, Sanitas University, Clinica Colsanitas, Bogota, Colombia.
| | - Nancy Yomayusa
- Renal Transplantation Group, Clinica Reina Sofia, University Clinic, Bogota, Colombia; Translational Investigation Group, Sanitas University, Clinica Colsanitas, Bogota, Colombia; Infectious Diseases Department, Clinica Colsanitas, Bogota, Colombia
| | - Rodolfo Torres
- Renal Transplantation Group, Clinica Reina Sofia, University Clinic, Bogota, Colombia; Translational Investigation Group, Sanitas University, Clinica Colsanitas, Bogota, Colombia
| | - Jorge Cortes
- Facultad de Medicina, Universidad Nacional de Colombia
| | - Carlos Alvarez
- Translational Investigation Group, Sanitas University, Clinica Colsanitas, Bogota, Colombia; Infectious Diseases Department, Clinica Colsanitas, Bogota, Colombia
| | - Juan Gallo
- Renal Transplantation Group, Clinica Reina Sofia, University Clinic, Bogota, Colombia
| | - Guillermo Aldana
- Renal Transplantation Group, Clinica Reina Sofia, University Clinic, Bogota, Colombia
| | - Andres Acevedo
- Renal Transplantation Group, Clinica Reina Sofia, University Clinic, Bogota, Colombia; Translational Investigation Group, Sanitas University, Clinica Colsanitas, Bogota, Colombia
| | - Maria Rios
- Molecular Biology and Immunology Laboratory, Clinica Colsanitas, Bogota, Colombia
| | - Johana Echeverri
- Molecular Biology and Immunology Laboratory, Clinica Colsanitas, Bogota, Colombia
| | - Zuly Yepes
- Molecular Biology and Immunology Laboratory, Clinica Colsanitas, Bogota, Colombia
| | - Adriana Silva
- Renal Transplantation Group, Clinica Reina Sofia, University Clinic, Bogota, Colombia
| | - Diana Gayon
- Renal Transplantation Group, Clinica Reina Sofia, University Clinic, Bogota, Colombia
| | - Jorge Perez
- Renal Transplantation Group, Clinica Reina Sofia, University Clinic, Bogota, Colombia; Translational Investigation Group, Sanitas University, Clinica Colsanitas, Bogota, Colombia; Infectious Diseases Department, Clinica Colsanitas, Bogota, Colombia; Molecular Biology and Immunology Laboratory, Clinica Colsanitas, Bogota, Colombia
| | - Milciades Ibanez
- Renal Transplantation Group, Clinica Reina Sofia, University Clinic, Bogota, Colombia; Translational Investigation Group, Sanitas University, Clinica Colsanitas, Bogota, Colombia
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5
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Märtson AG, Edwina AE, Kim HY, Knoester M, Touw DJ, Sturkenboom MGG, Alffenaar JWC. Therapeutic Drug Monitoring of Ganciclovir: Where Are We? Ther Drug Monit 2022; 44:138-147. [PMID: 34610621 PMCID: PMC8746890 DOI: 10.1097/ftd.0000000000000925] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ganciclovir is the mainstay of therapy for the prophylaxis and treatment of Cytomegalovirus. However, therapy with this antiviral agent is hindered by side effects such as myelosuppression, which often leads to therapy cessation. Underdosing, as an attempt to prevent side effects, can lead to drug resistance and therapy failure. Therapeutic drug monitoring (TDM) has been used to overcome these problems. The purpose of this narrative review was to give an overview of ganciclovir TDM, available assays, population pharmacokinetic models, and discuss the current knowledge gaps. METHODS For this narrative review, a nonsystematic literature search was performed on the PubMed database in April 2021. The following search terms were used: ganciclovir, valganciclovir, pharmacokinetics, pharmacodynamics, population pharmacokinetics, therapeutic drug monitoring, bioassay, liquid chromatography coupled with tandem mass spectrometry, liquid chromatography, chromatography, spectrophotometry, and toxicity. In addition, the reference lists of the included articles were screened. RESULTS The most common bioanalysis method identified was liquid chromatography coupled with tandem mass spectrometry. There are different models presenting ganciclovir IC50; however, establishing a pharmacokinetic/pharmacodynamic target for ganciclovir based on preclinical data is difficult because there are no studies combining dynamic drug exposure in relation to inhibition of viral replication. The data on ganciclovir TDM show large interindividual variability, indicating that TDM may play a role in modifying the dose to reduce toxicity and prevent treatment failure related to low concentrations. The main hurdle for implementing TDM is the lack of robust data to define a therapeutic window. CONCLUSIONS Although the pharmacokinetics (PK) involved is relatively well-described, both the pharmacodynamics (PD) and pharmacokinetic/pharmacodynamic relationship are not. This is because the studies conducted to date have mainly focused on estimating ganciclovir exposure, and owing to the limited therapeutic options for CMV infections, future studies on ganciclovir are warranted.
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Affiliation(s)
- Anne-Grete Märtson
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Angela E. Edwina
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hannah Yejin Kim
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Department of Pharmacy, Westmead Hospital, Westmead, NSW, Australia
- Marie Bashir Institute of Infectious Diseases and Biosecurity, The University of Sydney, Camperdown, NSW, Australia
| | - Marjolein Knoester
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; and
| | - Daan J. Touw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marieke G. G. Sturkenboom
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jan-Willem C. Alffenaar
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Department of Pharmacy, Westmead Hospital, Westmead, NSW, Australia
- Marie Bashir Institute of Infectious Diseases and Biosecurity, The University of Sydney, Camperdown, NSW, Australia
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A Case Report of COVID-19 in a Living Kidney Transplant Recipient: A Challenging Case with Complete Rehabilitation. Case Rep Urol 2022; 2022:2517674. [PMID: 35083091 PMCID: PMC8786476 DOI: 10.1155/2022/2517674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/29/2021] [Accepted: 12/03/2021] [Indexed: 01/08/2023] Open
Abstract
Adjustment of immunosuppressive and COVID-19 treatment in terms of drug interactions is still challenging. Herein, we report a 45-year-old woman with end-stage renal disease due to autosomal dominant polycystic diseases (ADPKD) with COVID-19 and pulmonary involvement following kidney transplantation. The patient was properly treated by discontinuation of immunosuppressive drugs, bronchoscopy, and high volume of blood transfusions. The fact that we quickly used early intubation and a new treatment regimen that suppressed immune systems may help physicians develop optimal treatment strategies for similar severe cases. However, this treatment method requires more detailed evaluations due to the contradictory results in reviewing other studies.
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Pizzo H, Shin B, Garrison J, Huang E, Malekzadeh M, Jordan SC, Puliyanda D, Toyoda M. Development of CMV-specific cytotoxic T cells (CMV-Tc) in pediatric renal transplant recipients with CMV viremia. Pediatr Transplant 2021; 25:e14119. [PMID: 34390094 DOI: 10.1111/petr.14119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/09/2021] [Accepted: 08/02/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Viral infections are controlled primarily by viral-specific T cells, raising concern for adequate T-cell response to clear CMV infection in transplant recipients receiving lymphocyte-depleting agents (LDA). We examined the rates of CMV viremia and clearance, seroconversion, and CMV-specific CD8+ T cell (CMV-Tc) activity with class of induction agent received. METHODS Retrospective review of 45 pediatric renal transplant recipients who received induction with LDA (n = 31) or non-LDA (NLDA; n = 14) received valganciclovir prophylaxis for 6 months post-transplant and CMV-PCR monitoring. CMV-Tc was measured by intracellular IFNγ flow cytometry, when possible, at baseline, 1 month after CMV viremia (>5 copies/PCR) and serially until CMV-Tc was positive (≥0.2%). RESULTS Viremia rates at 1, 2, and 4 years post-transplant were higher in LDA vs. NLDA (46.3% vs. 7.2%, 64.2% vs. 7.2%, and 64.2% vs. 7.2%, respectively; p = .002). Viremia rates at these time points in seronegative LDA (50.3%, 71.6%, 71.6%) were significantly or near significantly higher than seronegative NLDA (9.1%, 9.1%, 9.1%; p = .004), seropositive-LDA (22.3%, 22.3%, 22.3%; p = .07), or seropositive NLDA (0%, 0%, 0%; p = .07). Eleven of 17 (64.7%) viremic subjects required valganciclovir dose reduction during the prophylaxis period for leukopenia. All viremic LDA patients developed CMV-Tc. One viremic NLDA patient did not develop CMV-Tc. No patients developed CMV disease. CONCLUSION CMV seronegative pediatric renal transplant patients receiving LDA are more likely to have valganciclovir prophylaxis dose reduction and develop subclinical CMV viremia; however, all developed CMV-Tc. Larger prospective studies are needed to further understand the effects of induction agents on CMV-Tc and CMV-Tc's role post-transplant.
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Affiliation(s)
- Helen Pizzo
- Pediatric Nephrology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bongha Shin
- Transplant Immunology Laboratory and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jon Garrison
- Transplant Immunology Laboratory and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Edmund Huang
- Transplant Immunology Laboratory and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mohammad Malekzadeh
- Pediatric Nephrology, University of California Los Angeles, Los Angeles, CA, USA
| | - Stanley C Jordan
- Transplant Immunology Laboratory and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dechu Puliyanda
- Pediatric Nephrology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mieko Toyoda
- Transplant Immunology Laboratory and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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8
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A Retrospective Review of Calcineurin Inhibitors’ Impact on Cytomegalovirus Infections in Lung Transplant Recipients. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2040045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Immunosuppressive therapy reduces the risk for allograft rejection but leaves recipients susceptible to infections. Cytomegalovirus (CMV) is one of the most frequent causes for infection after transplantation and increases the risk for allograft rejection. As lung transplant recipients (LTRs) need to be under immunosuppression for life, they are a vulnerable group. To determine the potential association between the development of CMV infection and the calcineurin inhibitor (CNI) blood levels within previous 90 days, a retrospective review of LTRs was performed. Data from recipients who underwent a lung transplantation (LTx) at our center from January 2011 to December 2018 were collected. The studied recipients, after case/control matching, included 128 CMV-infection cases. The median time from the transplant to the first positive CMV viral load was 291.5 days. In our study, more patients were treated with tacrolimus (91.9%) than with cyclosporine (8.1%). Drug blood levels at selected timepoints showed no statistically significant difference between cases and controls. However, we found that CMV infection was more frequent in the donor-seropositive/recipient-seronegative group, interstitial lung disease (ILD) recipients, LTRs who underwent basiliximab induction, cyclosporine treated recipients, and LTRs with lymphopenia (at the time of CMV infection and 90 days before). In this review of LTRs, no association between the CNI blood level and CMV infection was seen, although other immunity-related factors were found to be influencing, i.e., basiliximab induction, cyclosporine treatment, and lymphopenia.
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Low dose thymoglobulin versus basiliximab in cytomegalovirus positive kidney transplant recipients: Effectiveness of preemptive cytomegalovirus modified strategy. Nefrologia 2021. [DOI: 10.1016/j.nefro.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Páez-Vega A, Gutiérrez-Gutiérrez B, Agüera ML, Facundo C, Redondo-Pachón D, Suñer M, López-Oliva MO, Yuste JR, Montejo M, Galeano-Álvarez C, Ruiz-San Millan JC, Los-Arcos I, Hernández D, Fernández-Ruiz M, Muñoz P, Valle-Arroyo J, Cano A, Rodríguez-Benot A, Crespo M, Rodelo-Haad C, Lobo-Acosta MA, Garrido-Gracia JC, Vidal E, Guirado L, Cantisán S, Torre-Cisneros J. Immunoguided Discontinuation of Prophylaxis for Cytomegalovirus Disease in Kidney Transplant Recipients Treated with Antithymocyte Globulin: A Randomized Clinical Trial. Clin Infect Dis 2021; 74:757-765. [PMID: 34228099 DOI: 10.1093/cid/ciab574] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Antiviral prophylaxis is recommended in cytomegalovirus (CMV)-seropositive kidney transplant (KT) recipients receiving antithymocyte globulin (ATG) as induction. An alternative strategy of premature discontinuation of prophylaxis after CMV-specific cell-mediated immunity (CMV-CMI) recovery (immunoguided prevention) has not been studied. The aim of this study was to evaluate whether it is effective and safe to discontinue prophylaxis when CMV-CMI is detected and to continue with preemptive therapy. METHODS In this open-label, non-inferiority clinical trial, patients were randomized 1:1 to follow immunoguided strategy, receiving prophylaxis (valganciclovir 900 mg daily) until CMV-CMI recovery or to receive fixed-duration prophylaxis until day +90. After prophylaxis, preemptive therapy (valganciclovir 900 mg twice daily) was indicated in both arms until month 6. The primary and secondary outcomes were incidence of CMV disease and replication, respectively, within the first 12 months. Desirability of outcome ranking (DOOR) assessed two deleterious events (CMV disease/replication and neutropenia). RESULTS A total of 150 CMV-seropositive KT recipients were randomly assigned. There was no difference in the incidence of CMV disease (0% vs. 2.7%; P = 0.149) and replication (17.1% vs. 13.5%; log-rank test, P = 0.422) between both arms. Incidence of neutropenia was lower in the immunoguided arm (9.2% vs. 37.8%; OR, 6.0; P < 0.001). A total of 66.1% of patients in the immunoguided arm showed a better DOOR, indicating a greater likelihood of a better outcome. CONCLUSIONS Prophylaxis can be prematurely discontinued in CMV-seropositive KT patients receiving ATG when CMV-CMI is recovered since no significant increase in the incidence of CMV replication or disease is observed.
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Affiliation(s)
- Aurora Páez-Vega
- Maimónides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Cordoba (UCO), Cordoba, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001, RD16/0016/0002, RD16/0016/0003, RD16/0016/0007, RD16/0016/0008, RD16/0016/0009 and RD16/0016/0012), Instituto de Salud Carlos III, Madrid, Spain
| | - Belén Gutiérrez-Gutiérrez
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine. Virgen Macarena University Hospital/ University of Seville. Biomedicine Institute of Seville (IBiS), Seville, Spain
| | - Maria L Agüera
- Maimónides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Cordoba (UCO), Cordoba, Spain.,Nephrology Service, Reina Sofia University Hospital, RedInRen (RD16/0009/0034), Cordoba, Spain
| | - Carme Facundo
- Renal Transplant Unit, Nephrology Service, Fundació Puigvert, Institut Investigació Biosanitaria Sant Pau, Autonomous University of Barcelona (UAB), RedInRen (RD16/0009/0019), Barcelona, Spain
| | - Dolores Redondo-Pachón
- Nephrology Service, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), RedInRen (RD16/0009/0013), Barcelona, Spain
| | - Marta Suñer
- Nephrology Service, Virgen del Rocío University Hospital, Seville, Spain
| | - Maria O López-Oliva
- Nephrology Service, La Paz University Hospital, RedInRen (RD16/0009/0008), Madrid, Spain
| | - Jose R Yuste
- Infectious Diseases Unit, Clinic University of Navarra, Pamplona, Spain
| | - Miguel Montejo
- Infectious Diseases Service, Cruces University Hospital, Bilbao, Spain
| | - Cristina Galeano-Álvarez
- Nephrology Service, Ramón y Cajal University Hospital, IRYCIS, RedInRen (RD16/0009/0014), Madrid, Spain
| | - Juan C Ruiz-San Millan
- Nephrology Service, Marqués de Valdecilla Hospital, University of Cantabria, IDIVAL, RedInRen (RD16/0009/0027), Santander, Spain
| | - Ibai Los-Arcos
- Infectious Diseases Service, Vall d' Hebron University Hospital, Barcelona, Spain
| | - Domingo Hernández
- Nephrology Service, Carlos Haya Regional University Hospital, Institute for Biomedical Research of Malaga (IBIMA), Universidad of Malaga, RedInRen (RD16/0009/0006), Malaga, Spain
| | - Mario Fernández-Ruiz
- Infectious Diseases Unit, 12 de Octubre University Hospital, Health Research Institute (imas12), Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Gregorio Marañon University Hospital, Madrid, Spain. Gregorio Marañón Biomedical Research Institute, Madrid, Spain. Department of Medicine, Complutense University of Madrid, Madrid, Spain. CIBERES (CB06/06/0058), Madrid, Spain
| | - Jorge Valle-Arroyo
- Maimónides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Cordoba (UCO), Cordoba, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001, RD16/0016/0002, RD16/0016/0003, RD16/0016/0007, RD16/0016/0008, RD16/0016/0009 and RD16/0016/0012), Instituto de Salud Carlos III, Madrid, Spain
| | - Angela Cano
- Maimónides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Cordoba (UCO), Cordoba, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001, RD16/0016/0002, RD16/0016/0003, RD16/0016/0007, RD16/0016/0008, RD16/0016/0009 and RD16/0016/0012), Instituto de Salud Carlos III, Madrid, Spain
| | - Alberto Rodríguez-Benot
- Maimónides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Cordoba (UCO), Cordoba, Spain.,Nephrology Service, Reina Sofia University Hospital, RedInRen (RD16/0009/0034), Cordoba, Spain
| | - Marta Crespo
- Nephrology Service, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), RedInRen (RD16/0009/0013), Barcelona, Spain
| | - Cristian Rodelo-Haad
- Maimónides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Cordoba (UCO), Cordoba, Spain.,Nephrology Service, Reina Sofia University Hospital, RedInRen (RD16/0009/0034), Cordoba, Spain
| | - María A Lobo-Acosta
- Clinical Trials Unit, Virgen del Rocio University Hospital (CTU-HUVR), (SCReNPT13/0002/0010-PT17/0017/0012). Seville, Spain
| | - Jose C Garrido-Gracia
- Clinical Trials Unit, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofia University Hospital/University of Cordoba (SCReN PT13/0002/0014, PT17/0017/0032), Cordoba, Spain
| | - Elisa Vidal
- Maimónides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Cordoba (UCO), Cordoba, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001, RD16/0016/0002, RD16/0016/0003, RD16/0016/0007, RD16/0016/0008, RD16/0016/0009 and RD16/0016/0012), Instituto de Salud Carlos III, Madrid, Spain.,Infectious Diseases Service, Reina Sofia University Hospital, Cordoba, Spain
| | - Luis Guirado
- Renal Transplant Unit, Nephrology Service, Fundació Puigvert, Institut Investigació Biosanitaria Sant Pau, Autonomous University of Barcelona (UAB), RedInRen (RD16/0009/0019), Barcelona, Spain
| | - Sara Cantisán
- Maimónides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Cordoba (UCO), Cordoba, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001, RD16/0016/0002, RD16/0016/0003, RD16/0016/0007, RD16/0016/0008, RD16/0016/0009 and RD16/0016/0012), Instituto de Salud Carlos III, Madrid, Spain
| | - Julián Torre-Cisneros
- Maimónides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Cordoba (UCO), Cordoba, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001, RD16/0016/0002, RD16/0016/0003, RD16/0016/0007, RD16/0016/0008, RD16/0016/0009 and RD16/0016/0012), Instituto de Salud Carlos III, Madrid, Spain.,Infectious Diseases Service, Reina Sofia University Hospital, Cordoba, Spain
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11
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Andrade-Sierra J, Heredia-Pimentel A, Rojas-Campos E, Ramírez Flores D, Cerrillos-Gutierrez JI, Miranda-Díaz AG, Evangelista-Carrillo LA, Martínez-Martínez P, Jalomo-Martínez B, Gonzalez-Espinoza E, Gómez-Navarro B, Medina-Pérez M, Nieves-Hernández JJ. Cytomegalovirus in renal transplant recipients from living donors with and without valganciclovir prophylaxis and with immunosuppression based on anti-thymocyte globulin or basiliximab. Int J Infect Dis 2021; 107:18-24. [PMID: 33862205 DOI: 10.1016/j.ijid.2021.04.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In our population, anti-thymocyte globulin (ATG) of 1 mg/Kg/day for 4 days is used; which permits not using valgancyclovir (VGC) prophylaxis in some renal transplant recipients (RTR) with moderate risk (R+), to reduce costs. This study aimed to determine the incidence and risk of developing cytomegalovirus (CMV), with or without prophylaxis, when exposed to low doses of ATG or basiliximab (BSL). PATIENTS AND METHODS A retrospective cohort included 265 RTR with follow-up of 12 months. Prophylaxis was used in R-/D+ and some R+. Tacrolimus (TAC), mycophenolate mofetil, and prednisone were used in all patients. Logistic regression analysis was performed to estimate the risk of CMV in RTR with or without VGC. RESULTS Cytomegalovirus was documented in 46 (17.3%) patients: 20 (43.5%) with CMV infection, and 26 (56.5%) with CMV disease. Anti-thymocyte globulin was used in 39 patients (85%): 32 R+, six D+/R-, and one D-/R-. ATG was used in 90% (27 of 30) of patients with CMV and without prophylaxis. The multivariate analysis showed an association of risk for CMV with the absence of prophylaxis (RR 2.29; 95% CI 1.08-4.86), ATG use (RR 3.7; 95% CI 1.50-9.13), TAC toxicity (RR 3.77; 95% CI 1.41-10.13), and lymphocytes at the sixth post-transplant month (RR 1.77; 95% CI 1.0-3.16). CONCLUSIONS Low doses of ATG favored the development of CMV and a lower survival free of CMV compared with BSL. In scenarios where resources for employing VGC are limited, BSL could be an acceptable strategy.
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Affiliation(s)
- Jorge Andrade-Sierra
- Department of Physiology, University Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico; Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico.
| | - Alejandro Heredia-Pimentel
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Enrique Rojas-Campos
- Medical Research Unit in Renal Diseases, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Diana Ramírez Flores
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - José I Cerrillos-Gutierrez
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Alejandra G Miranda-Díaz
- Department of Physiology, University Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Luis A Evangelista-Carrillo
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Petra Martínez-Martínez
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Basilio Jalomo-Martínez
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Eduardo Gonzalez-Espinoza
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Benjamin Gómez-Navarro
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Miguel Medina-Pérez
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Juan José Nieves-Hernández
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
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12
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Von Stein L, Leino AD, Pesavento T, Rajab A, Winters H. Antithymocyte induction dosing and incidence of opportunistic viral infections using steroid-free maintenance immunosuppression. Clin Transplant 2020; 35:e14102. [PMID: 32985025 DOI: 10.1111/ctr.14102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 09/10/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Currently, there is limited literature evaluating rATG induction dosing and incidence of opportunistic viral infections when using steroid-free maintenance immunosuppression. METHODS This single-center, retrospective, study compared high rATG (>4.5 mg/kg) versus low (<4.5 mg/kg) induction dosing and the overall incidence of early opportunistic viral infection at 180 days in the setting of maintenance immunosuppression consisting of tacrolimus, mycophenolate, rapid steroid withdrawal, and a tiered antiviral prevention strategy based on donor-recipient Cytomegalovirus (CMV) serostatus. RESULTS A total of 209 patients were included; 76 patients received low-dose and 133 patients received high-dose rATG. Incidence of overall opportunistic viral infection occurred more frequently in patients who received high compared to low dose (29.8% vs 25% p = .030). Incidence of CMV infection was also significantly increased in the high-dose group (31.6% vs 18.4% p = .039). In a multivariable model, rATG dose, as a continuous variable, remained a significant independent predictor of infection along with CMV risk (OR 1.46, 95% CI 1.02-2.09) controlling for age and CMV risk. There were no differences in graft-related outcomes at 180 days. CONCLUSION Higher cumulative rATG induction dose was associated with increased incidence of opportunistic viral infections, in the setting of a steroid-free maintenance immunosuppression in the early post-transplant period.
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Affiliation(s)
- Lauren Von Stein
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Abbie D Leino
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Todd Pesavento
- Nephrology, Department of Internal Medicine, Ohio State University, Columbus, OH, USA
| | - Amer Rajab
- Division of Transplantation, Department of General Surgery, Ohio State University College of Medicine, Columbus, OH, USA
| | - Holli Winters
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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13
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Deliège PG, Bastien J, Mokri L, Guyot-Colosio C, Arndt C, Rieu P. Belatacept associated - cytomegalovirus retinitis in a kidney transplant recipient: a case report and review of the literature. BMC Ophthalmol 2020; 20:468. [PMID: 33256663 PMCID: PMC7708192 DOI: 10.1186/s12886-020-01741-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/23/2020] [Indexed: 11/17/2022] Open
Abstract
Background To report the first case of belatacept-associated multidrug-resistant Cytomegalovirus retinitis in a kidney transplant recipient. Case presentation A 76-year-old African male renal allograft recipient was admitted for acute visual loss of the right eye. Ophthalmological examination of the right eye showed anterior uveitis and vitritis associated with large paravascular haemorrhages and yellow necrotic borders, involving the posterior pole but not the fovea. Both Cytomegalovirus DNA in plasma and aqueous humor were positive. The patient had had several episodes of Cytomegalovirus reactivation subsequent to the introduction of belatacept. His cytomegalovirus was multi-drug resistant, and was treated with maribarir, intravitreal and systemic injections of foscarnet, and anti-Cytomegalovirus human immunoglobulin. In parallel, belatacept was stopped and switched to tacrolimus. Cytomegalovirus DNA became undetectable and there was partial improvement of visual acuity at the last ophthalmologic examination, 18 months after the initial diagnosis of Cytomegalovirus retinitis. Conclusion Cytomegalovirus retinitis is an uncommon opportunistic infection in kidney transplant recipients. Cytomegalovirus retinitis is a serious infection because of the risk of blindness and the occurrence of associated life-threatening opportunistic infections. In view of the recent literature, kidney transplant recipients treated by belatacept immunosuppression may be at increased risk for Cytomegalovirus disease, notably Cytomegalovirus retinitis. The occurrence of Cytomegalovirus retinitis may help improve the selection of patients converted to belatacept.
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Affiliation(s)
| | - Justine Bastien
- Division of Ophtalmology, University Hospital of Reims, Reims, France
| | - Laetitia Mokri
- Division of Nephrology, University Hospital of Reims, Reims, France
| | | | - Carl Arndt
- Division of Ophtalmology, University Hospital of Reims, Reims, France
| | - Philippe Rieu
- Division of Nephrology, University Hospital of Reims, Reims, France.,Laboratory of Nephrology, UMR CNRS URCA 7369 (Matrice Extracellulaire et Dynamique Cellulaire, MEDyC), Reims, France
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14
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Chen D, Yang B, Zhang Y, Chen L, Wei L, Zhang W, Wang X, Tong X, Chen Z. Withdrawing mycophenolate mofetil in treating a young kidney transplant recipient with COVID-19: A case report. Medicine (Baltimore) 2020; 99:e20481. [PMID: 32541471 PMCID: PMC7302670 DOI: 10.1097/md.0000000000020481] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
RATIONALE Coronavirus disease 2019 (COVID-19) is a novel infectious disease and became a global issue. Treatment of COVID-19 especially in solid organ transplant recipients is empirical and controversial, especially the adjustment of the immunosuppressants. PATIENT CONCERNS A 29-year-old kidney transplant recipient with the symptoms of COVID-19 pneumonia. DIAGNOSES COVID-19 pneumonia after kidney transplantation. INTERVENTIONS He was treated with modified immunosuppressants (unchanged dose of tacrolimus and oral corticosteroids while discontinuing mycophenolate mofetil (MMF)), antibiotics, interferon α-2b inhalation and traditional Chinese medicine. OUTCOMES He recovered from COVID-19 pneumonia after 29 days of hospitalization. And the renal function (measured as blood urea nitrogen, serum creatinine, and urine protein) returned to normal. LESSONS In certain group of COVID-19 (e.g., mild to moderate cases, young patients without comorbidities), a reduction instead of an overall withdrawal of immunosuppressant in kidney transplant recipients is feasible.
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Affiliation(s)
- Dong Chen
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
- Key Laboratory of Organ Transplantation, Ministry of Education, Ministry of Public Health, Chinese Academy of Medical Sciences, Wuhan
| | - Bo Yang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
- Key Laboratory of Organ Transplantation, Ministry of Education, Ministry of Public Health, Chinese Academy of Medical Sciences, Wuhan
| | - Yan Zhang
- General Medical Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Liang Chen
- Endocrinology Department, Guanganmen Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Lai Wei
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
- Key Laboratory of Organ Transplantation, Ministry of Education, Ministry of Public Health, Chinese Academy of Medical Sciences, Wuhan
| | - Weijie Zhang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
- Key Laboratory of Organ Transplantation, Ministry of Education, Ministry of Public Health, Chinese Academy of Medical Sciences, Wuhan
| | - Xinqiang Wang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
- Key Laboratory of Organ Transplantation, Ministry of Education, Ministry of Public Health, Chinese Academy of Medical Sciences, Wuhan
| | - Xiaolin Tong
- Endocrinology Department, Guanganmen Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Zhishui Chen
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
- Key Laboratory of Organ Transplantation, Ministry of Education, Ministry of Public Health, Chinese Academy of Medical Sciences, Wuhan
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15
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Abstract
Lymphocyte depletion and blockade of T-cell activation and trafficking serve as therapeutic strategies for an enlarging number of immune-mediated diseases and malignancies. This review summarizes the infection risks associated to monoclonal antibodies that bind to the α chain of the interleukin-2 receptor, the cell surface glycoprotein CD52, and members of α4- and β2-integrin families acting as cell-adhesion molecules. An outline of the mechanisms of action, approved indications and off-label uses, expected impact on the host immune response, and available clinical evidence is provided for each of these agents.
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16
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Liu Y, Ye S, Zhou B, Zhang Y, Cui J, Zhang L, Dou Y, Song H, Liu X. The establishment of CMV antigen-specific enzyme-linked immunospot assay among Chinese: A pilot study. Clin Chim Acta 2019; 500:143-148. [PMID: 31655055 DOI: 10.1016/j.cca.2019.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 10/04/2019] [Accepted: 10/07/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The prevalence of cytomegalovirus in China is high and the infection could result in disastrous consequences. Cellular immunity is the main mechanism for virus controlling. We explored the performance of cytomegalovirus antigen-specific enzyme-linked immunospot assay in patients with different infection states in endemic area. METHODS Twenty-eight patients with reliable results were included in statistical analysis. Peripheral blood mononuclear cells were extracted and were stimulated by cytomegalovirus phosphoprotein 65 or immediate early protein-1 antigen respectively. Spot forming cells (SFCs) were counted to evaluate the cellular immune response elicited by antigens. RESULTS Spots could be clearly displayed, and evenly dispersed with a clean background. The numbers of SFCs were 0 [0-0], 426 [210-601] and 230 [57-513] for uninfected individuals (n = 7), latently infected patients (n = 11) and actively infected patients (n = 10) respectively, which were statistically different. The number of SFCs stimulated by phosphoprotein 65 was significantly higher than that by immediate early protein-1. CONCLUSIONS The number of SFCs was significantly different among patients with different infection state. The stimulatory effect of phosphoprotein 65 was better than that of immediate early protein-1.
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Affiliation(s)
- Yutong Liu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Susu Ye
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Baotong Zhou
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Centre for Tuberculosis Research, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yueqiu Zhang
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jingtao Cui
- Clinical Laboratories, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lifan Zhang
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Centre for Tuberculosis Research, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Clinical Epidemiology Unit, International Epidemiology Network, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yaling Dou
- Clinical Laboratories, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hongmei Song
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoqing Liu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Centre for Tuberculosis Research, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Clinical Epidemiology Unit, International Epidemiology Network, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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17
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Maertens J, Cordonnier C, Jaksch P, Poiré X, Uknis M, Wu J, Wijatyk A, Saliba F, Witzke O, Villano S. Maribavir for Preemptive Treatment of Cytomegalovirus Reactivation. N Engl J Med 2019; 381:1136-1147. [PMID: 31532960 DOI: 10.1056/nejmoa1714656] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Maribavir is a benzimidazole riboside with activity against cytomegalovirus (CMV). The safety and efficacy of maribavir for preemptive treatment of CMV infection in transplant recipients is not known. METHODS In a phase 2, open-label, maribavir dose-blinded trial, recipients of hematopoietic-cell or solid-organ transplants (≥18 years of age, with CMV reactivation [1000 to 100,000 DNA copies per milliliter]) were randomly assigned to receive maribavir at a dose of 400, 800, or 1200 mg twice daily or the standard dose of valganciclovir for no more than 12 weeks. The primary efficacy end point was the percentage of patients with a response to treatment, defined as confirmed undetectable CMV DNA in plasma, within 3 weeks and 6 weeks after the start of treatment. The primary safety end point was the incidence of adverse events that occurred or worsened during treatment. RESULTS Of the 161 patients who underwent randomization, 159 received treatment, and 156 had postbaseline data available - 117 in the maribavir group and 39 in the valganciclovir group. The percentage of patients with postbaseline data available who had a response to treatment within 3 weeks was 62% among those who received maribavir and 56% among those who received valganciclovir. Within 6 weeks, 79% and 67% of patients, respectively, had a response (risk ratio, 1.20; 95% confidence interval, 0.95 to 1.51). The percentages of patients with a response to treatment were similar among the maribavir dose groups. Two patients who had a response to treatment had a recurrence of CMV infection within 6 weeks after starting maribavir at a dose of 800 mg twice daily; T409M resistance mutations in CMV UL97 protein kinase developed in both patients. The incidence of serious adverse events that occurred or worsened during treatment was higher in the maribavir group than in the valganciclovir group (52 of 119 patients [44%] vs. 13 of 40 [32%]). A greater percentage of patients in the maribavir group discontinued the trial medication because of an adverse event (27 of 119 [23%] vs. 5 of 40 [12%]). A higher incidence of gastrointestinal adverse events was reported with maribavir, and a higher incidence of neutropenia was reported with valganciclovir. CONCLUSIONS Maribavir at a dose of at least 400 mg twice daily had efficacy similar to that of valganciclovir for clearing CMV viremia among recipients of hematopoietic-cell or solid-organ transplants. A higher incidence of gastrointestinal adverse events - notably dysgeusia - and a lower incidence of neutropenia were found in the maribavir group. (Funded by ViroPharma/Shire Development; EudraCT number, 2010-024247-32.).
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Affiliation(s)
- Johan Maertens
- From the Hematology Department, University Hospitals Leuven, KU Leuven, Leuven (J.M.), and the Section of Hematology, Cliniques Universitaires Saint-Luc, Brussels (X.P.) - both in Belgium; the Hematology Department, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University Paris-Est-Créteil, Créteil (C.C.), and AP-HP Hôpital Paul Brousse, Villejuif (F.S.) - all in France; the Medical University of Vienna, General Hospital, Vienna (P.J.); Shire, Wayne, PA (M.U., S.V.); Shire, Lexington, MA (J.W., A.W.); and the Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany (O.W.)
| | - Catherine Cordonnier
- From the Hematology Department, University Hospitals Leuven, KU Leuven, Leuven (J.M.), and the Section of Hematology, Cliniques Universitaires Saint-Luc, Brussels (X.P.) - both in Belgium; the Hematology Department, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University Paris-Est-Créteil, Créteil (C.C.), and AP-HP Hôpital Paul Brousse, Villejuif (F.S.) - all in France; the Medical University of Vienna, General Hospital, Vienna (P.J.); Shire, Wayne, PA (M.U., S.V.); Shire, Lexington, MA (J.W., A.W.); and the Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany (O.W.)
| | - Peter Jaksch
- From the Hematology Department, University Hospitals Leuven, KU Leuven, Leuven (J.M.), and the Section of Hematology, Cliniques Universitaires Saint-Luc, Brussels (X.P.) - both in Belgium; the Hematology Department, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University Paris-Est-Créteil, Créteil (C.C.), and AP-HP Hôpital Paul Brousse, Villejuif (F.S.) - all in France; the Medical University of Vienna, General Hospital, Vienna (P.J.); Shire, Wayne, PA (M.U., S.V.); Shire, Lexington, MA (J.W., A.W.); and the Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany (O.W.)
| | - Xavier Poiré
- From the Hematology Department, University Hospitals Leuven, KU Leuven, Leuven (J.M.), and the Section of Hematology, Cliniques Universitaires Saint-Luc, Brussels (X.P.) - both in Belgium; the Hematology Department, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University Paris-Est-Créteil, Créteil (C.C.), and AP-HP Hôpital Paul Brousse, Villejuif (F.S.) - all in France; the Medical University of Vienna, General Hospital, Vienna (P.J.); Shire, Wayne, PA (M.U., S.V.); Shire, Lexington, MA (J.W., A.W.); and the Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany (O.W.)
| | - Marc Uknis
- From the Hematology Department, University Hospitals Leuven, KU Leuven, Leuven (J.M.), and the Section of Hematology, Cliniques Universitaires Saint-Luc, Brussels (X.P.) - both in Belgium; the Hematology Department, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University Paris-Est-Créteil, Créteil (C.C.), and AP-HP Hôpital Paul Brousse, Villejuif (F.S.) - all in France; the Medical University of Vienna, General Hospital, Vienna (P.J.); Shire, Wayne, PA (M.U., S.V.); Shire, Lexington, MA (J.W., A.W.); and the Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany (O.W.)
| | - Jingyang Wu
- From the Hematology Department, University Hospitals Leuven, KU Leuven, Leuven (J.M.), and the Section of Hematology, Cliniques Universitaires Saint-Luc, Brussels (X.P.) - both in Belgium; the Hematology Department, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University Paris-Est-Créteil, Créteil (C.C.), and AP-HP Hôpital Paul Brousse, Villejuif (F.S.) - all in France; the Medical University of Vienna, General Hospital, Vienna (P.J.); Shire, Wayne, PA (M.U., S.V.); Shire, Lexington, MA (J.W., A.W.); and the Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany (O.W.)
| | - Anna Wijatyk
- From the Hematology Department, University Hospitals Leuven, KU Leuven, Leuven (J.M.), and the Section of Hematology, Cliniques Universitaires Saint-Luc, Brussels (X.P.) - both in Belgium; the Hematology Department, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University Paris-Est-Créteil, Créteil (C.C.), and AP-HP Hôpital Paul Brousse, Villejuif (F.S.) - all in France; the Medical University of Vienna, General Hospital, Vienna (P.J.); Shire, Wayne, PA (M.U., S.V.); Shire, Lexington, MA (J.W., A.W.); and the Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany (O.W.)
| | - Faouzi Saliba
- From the Hematology Department, University Hospitals Leuven, KU Leuven, Leuven (J.M.), and the Section of Hematology, Cliniques Universitaires Saint-Luc, Brussels (X.P.) - both in Belgium; the Hematology Department, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University Paris-Est-Créteil, Créteil (C.C.), and AP-HP Hôpital Paul Brousse, Villejuif (F.S.) - all in France; the Medical University of Vienna, General Hospital, Vienna (P.J.); Shire, Wayne, PA (M.U., S.V.); Shire, Lexington, MA (J.W., A.W.); and the Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany (O.W.)
| | - Oliver Witzke
- From the Hematology Department, University Hospitals Leuven, KU Leuven, Leuven (J.M.), and the Section of Hematology, Cliniques Universitaires Saint-Luc, Brussels (X.P.) - both in Belgium; the Hematology Department, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University Paris-Est-Créteil, Créteil (C.C.), and AP-HP Hôpital Paul Brousse, Villejuif (F.S.) - all in France; the Medical University of Vienna, General Hospital, Vienna (P.J.); Shire, Wayne, PA (M.U., S.V.); Shire, Lexington, MA (J.W., A.W.); and the Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany (O.W.)
| | - Stephen Villano
- From the Hematology Department, University Hospitals Leuven, KU Leuven, Leuven (J.M.), and the Section of Hematology, Cliniques Universitaires Saint-Luc, Brussels (X.P.) - both in Belgium; the Hematology Department, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University Paris-Est-Créteil, Créteil (C.C.), and AP-HP Hôpital Paul Brousse, Villejuif (F.S.) - all in France; the Medical University of Vienna, General Hospital, Vienna (P.J.); Shire, Wayne, PA (M.U., S.V.); Shire, Lexington, MA (J.W., A.W.); and the Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany (O.W.)
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Savassi-Ribas F, Gomes Dos Santos de Almeida S, Baez CF, Magalhães de Souza L, Wagner TCS, Matuck TA, Monteiro de Carvalho DDB, Marandino Guimarães MAA, Varella RB. Impact assessment and investigation of factors associated with herpesviruses viremia in the first year of renal transplantation. J Med Virol 2019; 92:107-112. [PMID: 31463932 DOI: 10.1002/jmv.25580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/26/2019] [Indexed: 12/16/2022]
Abstract
The increased risk for opportunistic infections after a renal transplant requires monitoring of viral infections to avoid future complications. Our goal was to investigate the impact and factors associated with Epstein-Barr virus (EBV), human cytomegalovirus (HCMV) and human herpesvirus type 6 (HHV-6) viremia in renal transplant recipients. Whole blood samples were collected monthly from 82 patients during the first semester and then quarterly up to 1 year after transplantation. EBV, HCMV, and HHV-6 were detected and quantified by TaqMan real-time polymerase chain reaction. The results showed that EBV and HCMV viremia were detected in 32 patients (39% each), while HHV-6 viremia in only 3 patients (3.7%). EBV was significantly associated with age (P = .050), thymoglobuline induction (P = .019), mTOR inhibitor-based therapy (P = .003), and female gender (P = .044). HCMV was significantly associated with basiliximab induction (P = .015), mycophenolate mofetil (MMF)-based therapy (P = .003) and allograft acute rejection (P = .033). Moreover, HCMV-disease was correlated with MMF-based therapy (P = .021) and female gender (P = .003). In conclusion, EBV and HCMV viremia were associated with different immunosuppressive induction and maintenance strategies. Additionally, higher HCMV viremia (> 10 4 copies/mL) was related to acute allograft rejection.
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Affiliation(s)
- Flavia Savassi-Ribas
- Department of Microbiology and Parasitology, Biomedical Institute, Fluminense Federal University, Niteroi, Brazil
| | | | - Camila Freze Baez
- Department of Preventive Medicine, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leandro Magalhães de Souza
- Department of Preventive Medicine, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tereza Cristina Simão Wagner
- Service of Renal Transplantation, Rio de Janeiro State Center of transplantation, São Francisco na Providência de Deus Hospital, Rio de Janeiro, Brazil
| | - Tereza Azevedo Matuck
- Service of Renal Transplantation, Rio de Janeiro State Center of transplantation, São Francisco na Providência de Deus Hospital, Rio de Janeiro, Brazil
| | - Deise De Boni Monteiro de Carvalho
- Service of Renal Transplantation, Rio de Janeiro State Center of transplantation, São Francisco na Providência de Deus Hospital, Rio de Janeiro, Brazil
| | | | - Rafael Brandão Varella
- Department of Microbiology and Parasitology, Biomedical Institute, Fluminense Federal University, Niteroi, Brazil
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19
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Jewani PK, Pouch SM, Kissling KT. Incidence of cytomegalovirus in cardiac transplant recipients receiving induction immunosuppression with antithymocyte globulin. Clin Transplant 2018; 32:e13420. [PMID: 30290013 DOI: 10.1111/ctr.13420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/23/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) is a major cause of morbidity and mortality in cardiac transplant recipients. Use of induction immunosuppression in cardiac transplantation may have an impact on the incidence of CMV, but literature is limited. METHODS Single-center, retrospective cohort study comparing the risk of CMV infection and disease in cardiac transplant patients receiving antithymocyte globulin (ATG) induction therapy to those receiving no antibody induction. RESULTS A total of 75 patients were included in our analysis, 50 who received ATG induction and 25 who did not. CMV infection occurred in 10 (20%) and 5 (20%) patients in the ATG and No ATG groups, respectively (P > 0.99). CMV disease occurred in 10 (20%) and 4 (16%) patients in the ATG and No ATG groups, respectively (P = 0.763). The median time from transplant to CMV infection was 200.0 [142.5, 364.5] days in the ATG group vs 221.0 [192.0, 299.0] days in the No ATG group (P = 0.723). The median time from end of CMV prophylaxis to CMV infection was 94.5 [66.5, 151.0] days in the ATG group vs 53.0 [41.0,149.5] days in the No ATG group (P = 0.202). Freedom from CMV infection was highest in the D+/R+ group and lowest in the D+/R- group. CONCLUSION In cardiac transplant recipients, ATG induction was not associated with an increased incidence of CMV infection or disease in the setting of valganciclovir prophylaxis and an initial maintenance immunosuppression regimen of primarily steroids, mycophenolate mofetil, and tacrolimus.
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Affiliation(s)
- Poonam K Jewani
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois
| | - Stephanie M Pouch
- Division of Infectious Diseases, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kevin T Kissling
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio
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20
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de Sandes-Freitas TV, Pinheiro PMA, Sales MLDMBO, Girão CM, Campos ÉF, Esmeraldo RDM. The impact of everolimus in reducing cytomegalovirus events in kidney transplant recipients on steroid-avoidance strategy: 3-year follow-up of a randomized clinical trial. Transpl Int 2018; 31:1345-1356. [PMID: 29969826 DOI: 10.1111/tri.13313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 05/29/2018] [Accepted: 06/28/2018] [Indexed: 12/28/2022]
Abstract
There is no evidence of whether everolimus (EVR) reduces cytomegalovirus (CMV) events in patients receiving steroid-free regimens. Besides, studies evaluating a tacrolimus (TAC) and EVR regimen are limited to 1-year follow-up. In this single-center prospective randomized trial, the incidence of CMV and 3-year efficacy and safety outcomes of EVR were compared to those of mycophenolate sodium (MPS) in a steroid-free regimen based on low-exposure TAC. Both groups received rabbit anti-thymocyte globulin (r-ATG) induction (6 mg/kg) and the steroids were withdrawn at day 7. Maintenance immunosuppression consisted of TAC (4-7 ng/ml until month 3 and 2-4 ng/ml thereafter) plus EVR (3-8 ng/ml) in the EVR group (n = 59); and TAC (4-7 ng/ml during all follow-up) plus MPS (1440 mg) in the MPS group (n = 56). The EVR group presented with a lower incidence of CMV events (18.6% vs. 50%, P = 0.001). No differences were observed in biopsy-proven acute rejection (6.8% vs. 3.6%, P = 0.680),graft loss (0.0% vs. 1.8%, P = 0.487),death (6.8% vs. 1.8%, P = 0.365), or estimated glomerular filtration rate at 36 months (61.1 ± 25.4 vs. 66.3 ± 24 ml/min/1.73 m2 , P = 0.369). A higher proportion of patients discontinued MPS treatment (8.5% vs. 26.8%, P = 0.013) for safety issues. In conclusion, EVR was associated with lower rates of CMV events in patients induced with standard dose r-ATG and a maintenance steroid-free regimen based on TAC. This regimen effectively prevented acute rejection and demonstrated a more favorable safety profile. (ClinicalTrials.gov:NCT02084446).
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Affiliation(s)
- Tainá Veras de Sandes-Freitas
- Transplant Division, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil.,Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | | | - Celi Melo Girão
- Transplant Division, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
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21
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Reusing JO, Feitosa EB, Agena F, Pierrotti LC, Azevedo LSF, Kotton CN, David-Neto E. Cytomegalovirus prophylaxis in seropositive renal transplant recipients receiving thymoglobulin induction therapy: Outcome and risk factors for late CMV disease. Transpl Infect Dis 2018; 20:e12929. [PMID: 29809309 DOI: 10.1111/tid.12929] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/29/2018] [Accepted: 04/04/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anti-thymocyte globulin (ATG) therapy is a risk factor for cytomegalovirus (CMV) disease in renal transplant (RTx) recipients and therefore antiviral prophylaxis is commonly used. We evaluated the outcome of our current policy of 90 days of CMV prophylaxis in seropositive recipients given ATG and the risk factors for the occurrence of CMV disease after prophylaxis. METHODS We studied a retrospective cohort of 423 RTx (2010-2014) CMV-seropositive adults given ATG induction therapy. RESULTS 54 (13%) patients developed CMV disease at a median of 163 days after transplant, of which 29 (54%) had viral syndrome and 25 (46%) had invasive disease. Median prophylaxis time (94 days) and immunosuppressive drugs were similar between groups (CMV vs no-CMV). Those with CMV disease had more deceased donors and higher donor age, lower lymphocyte count, and lower median eGFR at day 90. Multivariable logistic regression analysis at day 90 and 180 found that eGFR ≤40 ml/min/1.73 m2 (but not acute rejection) was associated with late CMV disease. In a separate validation cohort of 124 patients with 8% late CMV disease, eGFR ≤45 and lymphocyte count ≤800 cells/mm3 at the end of prophylaxis remained predictive of late CMV disease occurrence. CONCLUSIONS These data indicate that antiviral prophylaxis adequately prevented CMV in seropositive recipients given ATG, but late disease still occurred. Low eGFR and low lymphocyte count at the end of prophylaxis may help identify patients at higher risk of CMV disease.
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Affiliation(s)
- Jose O Reusing
- Renal Transplantation Service, Hospital das Clínicas, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Emanoela B Feitosa
- Renal Transplantation Service, Hospital das Clínicas, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Fabiana Agena
- Renal Transplantation Service, Hospital das Clínicas, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Lígia C Pierrotti
- Renal Transplantation Service, Hospital das Clínicas, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Luiz S F Azevedo
- Renal Transplantation Service, Hospital das Clínicas, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Camille N Kotton
- Transplant and Immunocompromised Host Infectious Diseases, Harvard Medical School, Infectious Diseases Division, Massachusetts General Hospital, Boston, MA, USA
| | - Elias David-Neto
- Renal Transplantation Service, Hospital das Clínicas, University of Sao Paulo Medical School, São Paulo, Brazil
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22
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Cristelli MP, Esmeraldo RM, Pinto CM, Sandes-Freitas TV, Felipe C, Lobo CF, Viana L, Mansur J, Stopa S, Santos DWC, Grenzi PC, Aguiar WF, Tedesco-Silva H, Pestana JOM. The influence of mTOR inhibitors on the incidence of CMV infection in high-risk donor positive-recipient negative (D+/R−) kidney transplant recipients. Transpl Infect Dis 2018; 20:e12907. [DOI: 10.1111/tid.12907] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/20/2018] [Accepted: 03/24/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Marina Pontello Cristelli
- Kidney Transplant Division; Hospital do Rim; São Paulo Brazil
- Universidade Federal de São Paulo; São Paulo Brazil
| | | | - Cahue Motta Pinto
- Kidney Transplant Division; Hospital do Rim; São Paulo Brazil
- Universidade Federal de São Paulo; São Paulo Brazil
| | - Taina Veras Sandes-Freitas
- Nephrology Division; Hospital Geral de Fortaleza; Fortaleza Brazil
- Clinical Medicine Division; Universidade Federal do Ceara; Fortaleza Brazil
| | - Claudia Felipe
- Kidney Transplant Division; Hospital do Rim; São Paulo Brazil
- Universidade Federal de São Paulo; São Paulo Brazil
| | | | - Laila Viana
- Kidney Transplant Division; Hospital do Rim; São Paulo Brazil
- Universidade Federal de São Paulo; São Paulo Brazil
| | - Juliana Mansur
- Kidney Transplant Division; Hospital do Rim; São Paulo Brazil
- Universidade Federal de São Paulo; São Paulo Brazil
| | - Suelen Stopa
- Kidney Transplant Division; Hospital do Rim; São Paulo Brazil
- Universidade Federal de São Paulo; São Paulo Brazil
| | - Daniel Wagner Castro Santos
- Kidney Transplant Division; Hospital do Rim; São Paulo Brazil
- Universidade Federal de São Paulo; São Paulo Brazil
| | - Patricia Cristina Grenzi
- Kidney Transplant Division; Hospital do Rim; São Paulo Brazil
- Universidade Federal de São Paulo; São Paulo Brazil
| | - Wilson Ferreira Aguiar
- Kidney Transplant Division; Hospital do Rim; São Paulo Brazil
- Universidade Federal de São Paulo; São Paulo Brazil
| | - Helio Tedesco-Silva
- Kidney Transplant Division; Hospital do Rim; São Paulo Brazil
- Universidade Federal de São Paulo; São Paulo Brazil
| | - Jose Osmar Medina Pestana
- Kidney Transplant Division; Hospital do Rim; São Paulo Brazil
- Universidade Federal de São Paulo; São Paulo Brazil
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Frange P, Leruez-Ville M. Maribavir, brincidofovir and letermovir: Efficacy and safety of new antiviral drugs for treating cytomegalovirus infections. Med Mal Infect 2018; 48:495-502. [PMID: 29650261 DOI: 10.1016/j.medmal.2018.03.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/22/2017] [Accepted: 03/16/2018] [Indexed: 12/15/2022]
Abstract
Cytomegalovirus (CMV) infection is a common complication in immunocompromised patients, especially after hematopoietic stem cell or solid organ transplantation. Therapeutic antiviral options [(val)ganciclovir, foscarnet, cidofovir] are still limited and can expose to severe toxicities. Moreover, prolonged antiviral drug exposure and ongoing viral replication are key factors in the development of antiviral drug resistance. After many years of few tangible advances in terms of new antiviral drugs, we are now experiencing an exciting period characterized by a series of phase III clinical trials incorporating three novel agents: maribavir, brincidofovir, and letermovir. This article summarizes the current state of the prevention and treatment of CMV infections as well as data of investigational drugs in clinical development.
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Affiliation(s)
- P Frange
- Laboratoire de microbiologie clinique, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris (AP-HP), 149, rue de Sèvres, 75015 Paris, France; Unité d'immunologie, hématologie et rhumatologie pédiatriques, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; EA7327, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France.
| | - M Leruez-Ville
- Laboratoire de microbiologie clinique, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris (AP-HP), 149, rue de Sèvres, 75015 Paris, France; EA7328, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France; CNR cytomégalovirus, laboratoire associé, 149, rue de Sèvres, 75015 Paris, France
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24
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Enzyme-Linked Immunospot Assay as a Complementary Method to Assess and Monitor Cytomegalovirus Infection in Kidney Transplant Recipients on Pre-emptive Antiviral Therapy: A Single-Center Experience. Transplant Proc 2018; 49:1766-1772. [PMID: 28923622 DOI: 10.1016/j.transproceed.2017.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/12/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) disease represents a major cause of post-transplantation morbidity and mortality. To estimate the risk of infection and monitor response to antiviral therapy, current guidelines suggest combination of viral load monitoring with direct assessment of CMV-specific immune response. We used enzyme-linked immunospot (ELISpot) for the evaluation of CMV-specific T-cell response in kidney transplant recipients with CMV viremia and investigated how information gained could help manage CMV infection. METHODS Seventeen patients on pre-emptive antiviral therapy and CMV quantitative polymerase chain reaction (qPCR) ≥500 copies/mL (first episode after transplantation) were assessed using ELISpot and divided into Weak (9 patients with baseline ELISpot <25 spot-forming colonies [SFCs]/200,000 peripheral blood mononuclear cells [PBMCs]) and Strong Responders (8 patients with baseline ELISpot ≥25 SFCs/200,000 PBMCs). CMV-specific T-cell response, infection severity, viral load, and antiviral therapy were prospectively recorded and compared between groups at 1, 2, and 24 months of follow-up. RESULTS Demographic and transplant characteristics of Weak and Strong Responders were similar. No episodes of CMV disease were observed. Weak Responders were more likely to experience CMV syndrome (56% vs 36.5%) and late virus reactivation (56% vs 25%) than Strong Responders. Weak Responders showed higher baseline median viral loads (19,700 vs 9265 copies/mL) and needed antiviral therapy for longer (179 vs 59.5 days). T-cell response showed 2 main patterns: early and delayed. CONCLUSIONS ELISpot provides prognostic information about infection severity, risk of late reactivation, and response to therapy. Randomized trials, evaluating the need for antiviral therapy in kidney transplant recipients with asymptomatic infection and effective virus-specific T-cell immune response, are warranted.
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25
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Ramirez CGB, McCauley J. Infection in Kidney Transplantation. CONTEMPORARY KIDNEY TRANSPLANTATION 2018. [PMCID: PMC7123753 DOI: 10.1007/978-3-319-19617-6_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Infection is an important cause of morbidity and mortality after kidney transplantation. It has been estimated that 70% of kidney transplant recipients will experience an infection episode within the first 3 years after transplantation (Dharnidharka et al. 2007). After cardiovascular disease, infection is the second leading cause of death in recipients with allograft function (Snyder et al. 2009). The immunosuppressive therapy required to prevent organ rejection places the kidney transplant recipient at increased risk for donor-derived, nosocomial, and community-acquired infections as well as reactivation of latent pathogens. Pretransplant screening, immunizations, and optimal antibacterial and antiviral prophylaxis can help to reduce the impact of infection. Awareness of the approach to infection in the transplant recipient including diagnostic and management strategies is essential to optimizing outcomes.
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Affiliation(s)
- Carlo Gerardo B. Ramirez
- Transplant Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania USA
| | - Jerry McCauley
- Division of Nephrology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania USA
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Zieliński M, Tarasewicz A, Zielińska H, Jankowska M, Moszkowska G, Dębska-Ślizień A, Rutkowski B, Trzonkowski P. Impact of donor and recipient human cytomegalovirus status on kidney transplantation. Int Immunol 2017; 29:541-549. [DOI: 10.1093/intimm/dxx062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/02/2017] [Indexed: 12/28/2022] Open
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Monforte V, Sintes H, López-Gallo C, Delgado M, Santos F, Zurbano F, Solé A, Gavaldá J, Borro JM, Redel-Montero J, Cifrian JM, Pastor A, Román A, Ussetti P. Risk factors, survival, and impact of prophylaxis length in cytomegalovirus-seropositive lung transplant recipients: A prospective, observational, multicenter study. Transpl Infect Dis 2017; 19. [PMID: 28294487 DOI: 10.1111/tid.12694] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/15/2016] [Accepted: 12/24/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND The optimal length of cytomegalovirus (CMV) prophylaxis in lung transplantation according to CMV serostatus is not well established. METHODS We have performed a prospective, observational, multicenter study to determine the incidence of CMV infection and disease in 92 CMV-seropositive lung transplant recipients (LTR), their related outcomes and risk factors, and the impact of prophylaxis length. RESULTS At 18 months post transplantation, 37 patients (40%) developed CMV infection (23 [25%]) or disease (14 [15.2%]). Overall mortality was higher in patients with CMV disease (64.3% vs 10.2%; P<.001), but only one patient died from CMV disease. In the multivariate analysis, CMV disease was an independent death risk factor (odds ratio [OR] 18.214, 95% confidence interval [CI] 4.120-80.527; P<.001). CMV disease incidence was higher in patients with 90-day prophylaxis than in those with 180-day prophylaxis (31.3% vs 11.8%; P=.049). Prophylaxis length was an independent risk factor for CMV disease (OR 4.974, 95% CI 1.231-20.094; P=.024). Sixteen patients withdrew from prophylaxis because of adverse events. CONCLUSION CMV infection and disease in CMV-seropositive LTR remain frequent despite current prophylaxis. CMV disease increases mortality, whereas 180-day prophylaxis reduces the incidence of CMV disease.
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Affiliation(s)
- Victor Monforte
- Respiratory Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Helena Sintes
- Respiratory Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Maria Delgado
- Thoracic Surgery Department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | - Felipe Zurbano
- Respiratory Department, Hospital Marqués de Valdecilla, Santander, Spain
| | - Amparo Solé
- Respiratory Department, Hospital La Fe, Valencia, Spain
| | - Joan Gavaldá
- Infectious Disease Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Jose Maria Borro
- Thoracic Surgery Department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | | | - Amparo Pastor
- Respiratory Department, Hospital La Fe, Valencia, Spain
| | - Antonio Román
- Respiratory Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Piedad Ussetti
- Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Respiratory Department, Hospital Puerta de Hierro, Madrid, Spain
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Feng S, Yang J, Wang W, Hu X, Liu H, Qian X, Feng D, Zhang X. Incidence and Risk Factors for Cytomegalovirus Infection in Patients With Kidney Transplantation: A Single-Center Experience. Transplant Proc 2017; 48:2695-2699. [PMID: 27788803 DOI: 10.1016/j.transproceed.2016.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/03/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) infection is deemed to be a major cause of morbidity and mortality in patients after kidney transplantation. The purpose of this study was to analyze the incidence of CMV infection and risk factors for CMV infection in our center, to help in determination of its impact on the kidney function in this patient population, and to provide new ideas for the prevention and treatment of CMV infection. METHODS A total of 319 kidney transplant recipients from our center were studied between January 2000 and December 2015. The CMV viral load in each kidney transplant patients was monitored with the use of CMV quantitative nucleic acid testing (CMV-QNAT). Laboratory data and other medical records were also collected. RESULTS The incidence of CMV infection was 8.8% in our studied patients. The patients within 3 to 6 months and 5 to 10 years after transplantation had a higher risk of CMV infection. CMV infection was probably correlated with lower white blood cell counts but elevated hemoglobin, serum creatinine, blood urea nitrogen, potassium, and estimated glomerular filtration rate (eGFR). Anti-CMV immunoglobulin (Ig)G and history of allograft rejection were also associated with CMV infection. In multivariate regression analysis, white blood cells, eGFR, anti-CMV IgG, and history of allograft rejection were the independent risk factors associated with CMV infection in kidney transplantation patients. CONCLUSIONS CMV infection was an important complication after kidney transplantation, particularly in these patients with allograft impairment.
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Affiliation(s)
- S Feng
- Institute of Uro-Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - J Yang
- Institute of Uro-Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - W Wang
- Institute of Uro-Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - X Hu
- Institute of Uro-Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - H Liu
- Institute of Uro-Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - X Qian
- Institute of Uro-Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - D Feng
- Institute of Uro-Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - X Zhang
- Institute of Uro-Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Bahrami A, Shams SF, Eidgahi ES, Lotfi Z, Sheikhi M, Shakeri S. Epidemiology of Infectious Complications in Renal Allograft Recipients in the First Year After Transplant. EXP CLIN TRANSPLANT 2017; 15:631-635. [PMID: 28176620 DOI: 10.6002/ect.2016.0068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Renal transplant is one of the best ways to extend life of patients in the end stage of renal disease. Infections are significant causes of morbidity and mortality after renal transplant. The aim of this study was to evaluate frequency, risk factors, causative pathogens, and clinical manifestations in renal transplant recipients from Mashhad City during the first year after transplant. MATERIALS AND METHODS This research was conducted at Montaserie Hospital of Mashhad University of Medical Sciences from March 2013 to July 2015. All studied cases were followed for 1 year. In this retrospective study, our study cohort comprised 193 kidney transplant recipients, including 118 male (61.1%) and 75 female (38.9%) patients, with mean age of 34.4 ± 12.2 years. Of the total patients, 58 received kidneys from living donors (30.1%) and 135 received kidneys from deceased donors (69.9%). RESULTS We found that 151 infectious episodes had occurred in 96 patients. The most common infectious site involved the urinary tract (39.1%). Escherichia coli was the most frequently isolated pathogen. The only significant infection risk factor to affect transplant outcomes during the first year was age. CONCLUSIONS Infections are highly prevalent during the first year after transplant. Prevention and effective antibiotic therapy can reduce the related adverse effects.
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Affiliation(s)
- Afsane Bahrami
- From the Student Research Committee, Department of Modern Sciences and Technologies, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran and Nephrology Kidney Transplantation Complication Research Center, Montaserie Organ Transplantation Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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30
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Recent Advances in Mammalian Target of Rapamycin Inhibitor Use in Heart and Lung Transplantation. Transplantation 2016; 100:2558-2568. [DOI: 10.1097/tp.0000000000001432] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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31
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Targeted preemptive therapy according to perceived risk of CMV infection after kidney transplantation. Braz J Infect Dis 2016; 20:576-584. [PMID: 27643978 PMCID: PMC9427657 DOI: 10.1016/j.bjid.2016.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/05/2016] [Accepted: 08/09/2016] [Indexed: 11/21/2022] Open
Abstract
Background Methods Results Conclusion
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32
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Pascual J, Royuela A, Fernández AM, Herrero I, Delgado JF, Solé A, Guirado L, Serrano T, de la Torre-Cisneros J, Moreno A, Cordero E, Gallego R, Lumbreras C, Aguado JM. Role of mTOR inhibitors for the control of viral infection in solid organ transplant recipients. Transpl Infect Dis 2016; 18:819-831. [PMID: 27600985 DOI: 10.1111/tid.12601] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/25/2016] [Accepted: 06/24/2016] [Indexed: 12/11/2022]
Abstract
Appropriate post-transplant immunosuppressive regimens that avoid acute rejection, while reducing risk of viral reactivation, have been sought, but remain a chimera. Recent evidence suggesting potential regulatory and antiviral effects of mammalian target of rapamycin inhibitors (mTORi) is of great interest. Although the concept of an immunosuppressive drug with antiviral properties is not new, little effort has been made to put the evidence together to assess the management of immunosuppressive therapy in the presence of a viral infection. This review was developed to gather the evidence on antiviral activity of the mTORi against the viruses that most commonly reactivate in adult solid organ recipients: cytomegalovirus (CMV), polyomavirus, Epstein-Barr virus (EBV), human herpesvirus 8 (HHV8), and hepatitis C virus (HCV). A rapid review methodology and evaluation of quality and consistency of evidence based on the GRADE system was used. The existing literature was variable in nature, although indicating a potential advantage of mTORi in CMV, polyomavirus, and HHV8 infection, and a most doubtful relation with EBV and HCV infection. Several recommendations about the management of these infections are presented that can change certain current patterns of immunosuppression and help to improve the prognosis of the direct and indirect effects of viral infection in solid organ recipients.
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Affiliation(s)
- Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain.,Institut Mar for Medical Research, Barcelona, Spain.,REDINREN Spanish Network for Renal Research RD12/0021, Barcelona, Spain
| | - Ana Royuela
- Clinical Biostatistics Unit, Puerta de Hierro University Hospital, Instituto de Investigacion Puerta de Hierro (IDIPHIM), Madrid, Spain
| | - Ana M Fernández
- REDINREN Spanish Network for Renal Research RD12/0021, Barcelona, Spain.,Department of Nephrology, Hospital Ramón y Cajal, IRICYS, Madrid, Spain
| | - Ignacio Herrero
- Liver Unit, Clínica Universidad de Navarra, CIBERehd, IdiSNA, Pamplona, Spain
| | - Juan F Delgado
- Department of Cardiology, Institute of Investigation 1+12, Universidad Complutense de Madrid, University Hospital 12 de Octubre, Madrid, Spain
| | - Amparo Solé
- Lung Transplant Unit, Hospital Universitario y Politecnico la FE, Universidad de Valencia, Valencia, Spain
| | - Lluis Guirado
- REDINREN Spanish Network for Renal Research RD12/0021, Barcelona, Spain.,Department of Nephrology, Fundació Puigvert, Barcelona, Spain
| | - Trinidad Serrano
- Liver Unit, University Hospital Lozano Blesa, Zaragoza, IIS Aragon, Spain
| | | | - Asunción Moreno
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Elisa Cordero
- Department of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen del Rocío, CSIC, University of Seville, Seville, Spain
| | - Roberto Gallego
- Department of Nephrology, Hospital Universitario de Gran Canaria Dr Negrin, Gran Canaria, Spain
| | - Carlos Lumbreras
- Unit of Infectious Diseases, Institute of Investigation 1+12, Universidad Complutense de Madrid, University Hospital 12 de Octubre, Madrid, Spain
| | - José M Aguado
- Unit of Infectious Diseases, Institute of Investigation 1+12, Universidad Complutense de Madrid, University Hospital 12 de Octubre, Madrid, Spain
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Cortés JA, Yomayusa N, Arias YR, Arroyave IH, Cataño JC, García P, Guevara FO, Mesa L, Montero C, Rios MF, Robayo A, Rosso F, Torres R, Uribe LG, González L, Alvarez CA. Consenso colombiano para la estratificación, diagnóstico, tratamiento y prevención de la infección por citomegalovirus en pacientes adultos con trasplante renal. INFECTIO 2016. [DOI: 10.1016/j.infect.2015.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Cervera C, Cofan F, Hernandez C, Soy D, Marcos MA, Sanclemente G, Bodro M, Moreno A, Diekmann F, Campistol JM, Oppenheimer F. Effect of mammalian target of rapamycin inhibitors on cytomegalovirus infection in kidney transplant recipients receiving polyclonal antilymphocyte globulins: a propensity score-matching analysis. Transpl Int 2016; 29:1216-1225. [DOI: 10.1111/tri.12848] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 05/13/2016] [Accepted: 08/17/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Carlos Cervera
- Division of Infectious Diseases; Department of Medicine; University of Alberta; Edmonton AB Canada
- Division of Infectious Diseases; IDIBAPS; Hospital Clinic of Barcelona; University of Barcelona; Barcelona Spain
| | - Frederic Cofan
- Renal Transplantation Unit; Division of Nephrology; IDIBAPS; Hospital Clinic of Barcelona; University of Barcelona; Barcelona Spain
| | - Cristina Hernandez
- Division of Infectious Diseases; Department of Medicine; University of Alberta; Edmonton AB Canada
| | - Dolors Soy
- Division of Pharmacy; IDIBAPS; Hospital Clinic of Barcelona; University of Barcelona; Barcelona Spain
| | - Maria Angeles Marcos
- Division of Microbiology; Centre Diagnòstic Biomèdic (CDB); Centre for International Health Research (CRESIB); IDIBAPS; Hospital Clinic of Barcelona; University of Barcelona; Barcelona Spain
| | - Gemma Sanclemente
- Division of Infectious Diseases; Department of Medicine; University of Alberta; Edmonton AB Canada
| | - Marta Bodro
- Division of Infectious Diseases; Department of Medicine; University of Alberta; Edmonton AB Canada
| | - Asunción Moreno
- Division of Infectious Diseases; Department of Medicine; University of Alberta; Edmonton AB Canada
| | - Fritz Diekmann
- Renal Transplantation Unit; Division of Nephrology; IDIBAPS; Hospital Clinic of Barcelona; University of Barcelona; Barcelona Spain
| | - Josep Maria Campistol
- Renal Transplantation Unit; Division of Nephrology; IDIBAPS; Hospital Clinic of Barcelona; University of Barcelona; Barcelona Spain
| | - Frederic Oppenheimer
- Renal Transplantation Unit; Division of Nephrology; IDIBAPS; Hospital Clinic of Barcelona; University of Barcelona; Barcelona Spain
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Torre-Cisneros J, Aguado J, Caston J, Almenar L, Alonso A, Cantisán S, Carratalá J, Cervera C, Cordero E, Fariñas M, Fernández-Ruiz M, Fortún J, Frauca E, Gavaldá J, Hernández D, Herrero I, Len O, Lopez-Medrano F, Manito N, Marcos M, Martín-Dávila P, Monforte V, Montejo M, Moreno A, Muñoz P, Navarro D, Pérez-Romero P, Rodriguez-Bernot A, Rumbao J, San Juan R, Vaquero J, Vidal E. Management of cytomegalovirus infection in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations. Transplant Rev (Orlando) 2016; 30:119-43. [DOI: 10.1016/j.trre.2016.04.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 04/02/2016] [Accepted: 04/04/2016] [Indexed: 02/06/2023]
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Kajiwara M, Masuda S. Role of mTOR Inhibitors in Kidney Disease. Int J Mol Sci 2016; 17:ijms17060975. [PMID: 27338360 PMCID: PMC4926507 DOI: 10.3390/ijms17060975] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/13/2016] [Accepted: 06/16/2016] [Indexed: 02/06/2023] Open
Abstract
The first compound that inhibited the mammalian target of rapamycin (mTOR), sirolimus (rapamycin) was discovered in the 1970s as a soil bacterium metabolite collected on Easter Island (Rapa Nui). Because sirolimus showed antiproliferative activity, researchers investigated its molecular target and identified the TOR1 and TOR2. The mTOR consists of mTOR complex 1 (mTORC1) and mTORC2. Rapalogues including sirolimus, everolimus, and temsirolimus exert their effect mainly on mTORC1, whereas their inhibitory effect on mTORC2 is mild. To obtain compounds with more potent antiproliferative effects, ATP-competitive inhibitors of mTOR targeting both mTORC1 and mTORC2 have been developed and tested in clinical trials as anticancer drugs. Currently, mTOR inhibitors are used as anticancer drugs against several solid tumors, and immunosuppressive agents for transplantation of various organs. This review discusses the role of mTOR inhibitors in renal disease with a particular focus on renal cancer, diabetic nephropathy, and kidney transplantation.
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Affiliation(s)
- Moto Kajiwara
- Department of Pharmacy, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Satohiro Masuda
- Department of Pharmacy, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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Young P, Rubin J, Angarone M, Flaherty J, Penugonda S, Stosor V, Ison M. Ganciclovir-resistant cytomegalovirus infection in solid organ transplant recipients: a single-center retrospective cohort study. Transpl Infect Dis 2016; 18:390-5. [DOI: 10.1111/tid.12537] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 01/23/2016] [Accepted: 02/13/2016] [Indexed: 12/20/2022]
Affiliation(s)
- P.G. Young
- The Christ Hospital Infectious Diseases Physicians; Cincinnati Ohio USA
| | - J. Rubin
- University of Illinois at Chicago School of Medicine; Chicago Illinois USA
| | - M. Angarone
- Division of Infectious Diseases Northwestern University Feinberg School of Medicine; Chicago Illinois USA
| | - J. Flaherty
- Division of Infectious Diseases Northwestern University Feinberg School of Medicine; Chicago Illinois USA
| | - S. Penugonda
- Division of Infectious Diseases Northwestern University Feinberg School of Medicine; Chicago Illinois USA
| | - V. Stosor
- Division of Infectious Diseases Northwestern University Feinberg School of Medicine; Chicago Illinois USA
- Division of Organ Transplantation; Northwestern University Feinberg School of Medicine; Chicago Illinois USA
| | - M.G. Ison
- Division of Infectious Diseases Northwestern University Feinberg School of Medicine; Chicago Illinois USA
- Division of Organ Transplantation; Northwestern University Feinberg School of Medicine; Chicago Illinois USA
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Malvezzi P, Jouve T, Rostaing L. Use of Everolimus-based Immunosuppression to Decrease Cytomegalovirus Infection After Kidney Transplant. EXP CLIN TRANSPLANT 2016; 14:361-6. [PMID: 27041365 DOI: 10.6002/ect.2015.0292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Cytomegalovirus infection and disease remain an issue in solid-organ transplant. Universal prophylaxis is more cost-effective than a preemptive strategy and is associated with significantly less Cytomegalovirus resistance after kidney transplant, especially in Cytomegalovirus-seropositive donors and Cytomegalovirus-seronegative recipients. MATERIALS AND METHODS Registry data and meta-analyses have shown that mammalian target of rapamycin inhibitors (sirolimus- and everolimus-based immunosuppression) are associated with significantly less Cytomegalovirus events in de novo kidney transplant patients than in patients who are treated with calcineurin inhibitors plus mycophenolate-based immunosuppression. RESULTS Recent pooled analyses of 3 randomized controlled trials in de novo kidney transplant patients, where immunosuppression was based on cyclosporine with either mycophenolate or everolimus, showed that patients who received everolimus had significantly less Cytomegalovirus events (Cytomegalovirus viremia, Cytomegalovirus infection/disease) than those who received mycophenolate, with or without cytomegalovirus as prophylaxis. An even more recent prospective randomized controlled study on de novo kidney transplant patients with no anticytomegalovirus prophylaxis demonstrated that everolimus-based immunosuppression plus low-dose tacrolimus was associated with significantly less Cytomegalovirus infection than standard-dose tacrolimus plus mycophenolate. CONCLUSIONS The potential benefits are not fully known of such a therapeutic strategy to limit the long-term indirect effects mediated by Cytomegalovirus infections.
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Affiliation(s)
- Paolo Malvezzi
- From the Clinique Universitaire de Néphrologie, Unité de Transplantation Rénale, CHU Grenoble
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39
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Frange P, Leruez-Ville M. Traitements antiviraux de l’infection sévère à cytomégalovirus – état des lieux et perspectives. MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-015-1157-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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40
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Lumbreras C, Manuel O, Len O, ten Berge IJM, Sgarabotto D, Hirsch HH. Cytomegalovirus infection in solid organ transplant recipients. Clin Microbiol Infect 2015; 20 Suppl 7:19-26. [PMID: 26451404 DOI: 10.1111/1469-0691.12594] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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41
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San-Juan R, Navarro D, García-Reyne A, Montejo M, Muñoz P, Carratala J, Len O, Fortun J, Muñoz-Cobo B, Gimenez E, Eworo A, Sabe N, Meije Y, Martin-Davila P, Andres A, Delgado J, Jimenez C, Amat P, Fernández-Ruiz M, López-Medrano F, Lumbreras C, Aguado JM. Effect of delaying prophylaxis against CMV in D+/R- solid organ transplant recipients in the development of CMV-specific cellular immunity and occurrence of late CMV disease. J Infect 2015; 71:561-70. [PMID: 26183297 DOI: 10.1016/j.jinf.2015.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 04/12/2015] [Accepted: 06/11/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Evaluate the protective effect against late CMV disease of delaying antiviral prophylaxis initiation in D+/R- patients receiving solid organ transplant (SOT). METHODS Prospective multicenter study in D+/R- SOT recipients in Spain (Sept/09-Sept/12). Whole blood specimens were prospectively collected after Tx for CMV-specific cell-mediated immunity (CMI) determination. Two prophylaxis strategies were compared: early prophylaxis (EP; starting within the first 3 days after Tx) and delayed prophylaxis (DP; starting 14 days after Tx). Risk factors for the occurrence of CMV disease were determined by survival analysis and proportional risk Cox regression models. RESULTS We included 95 patients (50 EP V 45 DP). Twenty six patients (27.4%) developed CMV disease: 32.7% EP vs. 20% DP; (p = 0.2). No cases of CMV disease were reported previously to beginning delayed prophylaxis. The percentage of individuals with detectable CMI response was higher in patients with DP although differences did not reach statistic significance (42% vs 29.6% at day 200 after Tx; p = 0.4). There was a clear trend towards less end-organ CMV disease in patients receiving DP (18.2% EP vs 5% DP; p = 0.09) and DP was the only protective factor in the multivariate analysis (HR: 0.26; CI: 0.05-1.2; p = 0.09). CONCLUSIONS A 14-day delay in CMV prophylaxis in D+/R- SOT recipients is safe and may reduce the incidence of late CMV end-organ disease although correlation of this effect with CMI responses was not complete.
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Affiliation(s)
- R San-Juan
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain.
| | - D Navarro
- Microbiology Service, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
| | - A García-Reyne
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - M Montejo
- Unit of Infectious Diseases, University Hospital de Cruces, Bilbao, Spain
| | - P Muñoz
- Department of Clinical Microbiology and Infectious Diseases, University Hospital Gregorio Marañon, Madrid, Spain
| | - J Carratala
- Department of Infectious Diseases, Department of Infectious Diseases, University Hospital Bellvitge-IDIBELL, Universidad de Barcelona, Barcelona, Spain
| | - O Len
- Department of Infectious Diseases, University Hospital Vall d'Hebron, Barcelona, Spain
| | - J Fortun
- Infectious Diseases Unit, University Hospital Ramon y Cajal, Madrid, Spain
| | - B Muñoz-Cobo
- Microbiology Service, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
| | - E Gimenez
- Microbiology Service, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
| | - A Eworo
- Department of Clinical Microbiology and Infectious Diseases, University Hospital Gregorio Marañon, Madrid, Spain
| | - N Sabe
- Department of Infectious Diseases, Department of Infectious Diseases, University Hospital Bellvitge-IDIBELL, Universidad de Barcelona, Barcelona, Spain
| | - Y Meije
- Department of Infectious Diseases, University Hospital Vall d'Hebron, Barcelona, Spain
| | - P Martin-Davila
- Infectious Diseases Unit, University Hospital Ramon y Cajal, Madrid, Spain
| | - A Andres
- Nephrology Service, Kidney Transplant Unit, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - J Delgado
- Cardiology Service, Heart Transplant Unit, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - C Jimenez
- General Abdominal Surgery Service, Intra-abdominal Transplant Unit, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - P Amat
- Haematology Service, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - F López-Medrano
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - C Lumbreras
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - J M Aguado
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
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A Cytomegalovirus-related Pseudotumor in the Colon of A Renal Transplant Recipient Shrunk by Antiviral Therapy. Transplantation 2015; 99:e46-7. [DOI: 10.1097/tp.0000000000000772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fernández-Ruiz M, Arias M, Campistol JM, Navarro D, Gómez-Huertas E, Gómez-Márquez G, Díaz JM, Hernández D, Bernal-Blanco G, Cofan F, Jimeno L, Franco-Esteve A, González E, Moreso FJ, Gómez-Alamillo C, Mendiluce A, Luna-Huerta E, Aguado JM. Cytomegalovirus prevention strategies in seropositive kidney transplant recipients: an insight into current clinical practice. Transpl Int 2015; 28:1042-54. [DOI: 10.1111/tri.12586] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/17/2014] [Accepted: 04/07/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Mario Fernández-Ruiz
- Unit of Infectious Diseases; Hospital Universitario “12 de Octubre”; Instituto de Investigación Hospital “12 de Octubre” (i+12); Madrid Spain
| | - Manuel Arias
- Department of Nephrology; Hospital Universitario “Marqués de Valdecilla”; Instituto de Formación e Investigación “Marqués de Valdecilla” (IFIMAV); Santander Spain
| | - Josep M. Campistol
- Department of Nephrology; Hospital Clinic; Institut d'Investigacions Biomèdiques “August Pi i Sunyer” (IDIBAPS); Barcelona Spain
| | - David Navarro
- Department of Microbiology; Hospital Clínico Universitario; Instituto de Investigación Sanitaria INCLIVA; University of Valencia; Valencia Spain
| | | | - Gonzalo Gómez-Márquez
- Department of Nephrology; Hospital Universitario Son Espases; Palma de Mallorca Spain
| | | | - Domingo Hernández
- Department of Nephrology; Hospital Universitario “Carlos Haya”; Málaga Spain
| | - Gabriel Bernal-Blanco
- Department of Nephrology; Hospital Universitario “Virgen del Rocío”; Instituto de Biomedicina de Sevilla (IBIS); Sevilla Spain
| | - Frederic Cofan
- Department of Nephrology; Hospital Clinic; Institut d'Investigacions Biomèdiques “August Pi i Sunyer” (IDIBAPS); Barcelona Spain
| | - Luisa Jimeno
- Department of Nephrology; Hospital Universitario “Virgen de la Arrixaca”; El Palmar; Murcia Spain
| | | | - Esther González
- Department of Nephrology; Hospital Universitario “12 de Octubre”; Instituto de Investigación Hospital “12 de Octubre” (i+12); Madrid Spain
| | - Francesc J. Moreso
- Department of Nephrology; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | - Carlos Gómez-Alamillo
- Department of Nephrology; Hospital Universitario “Marqués de Valdecilla”; Instituto de Formación e Investigación “Marqués de Valdecilla” (IFIMAV); Santander Spain
| | - Alicia Mendiluce
- Department of Nephrology; Hospital Clínico Universitario; Valladolid Spain
| | - Enrique Luna-Huerta
- Department of Nephrology; Hospital Universitario “Infanta Cristina”; Badajoz Spain
| | - José María Aguado
- Unit of Infectious Diseases; Hospital Universitario “12 de Octubre”; Instituto de Investigación Hospital “12 de Octubre” (i+12); Madrid Spain
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Vu D, Shah T, Ansari J, Sakharkar P, Yasir Q, Naraghi R, Hutchinson I, Min D. Interferon-gamma gene polymorphism +874 A/T is associated with an increased risk of cytomegalovirus infection among Hispanic renal transplant recipients. Transpl Infect Dis 2014; 16:724-32. [DOI: 10.1111/tid.12285] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 04/25/2014] [Accepted: 06/21/2014] [Indexed: 11/30/2022]
Affiliation(s)
- D. Vu
- Mendez National Institute of Transplantation; Los Angeles California USA
- Western University of Health Sciences; Pomona California USA
- Transplant Research Institute; Los Angeles California USA
- St. Vincent Medical Center; Los Angeles California USA
| | - T. Shah
- Western University of Health Sciences; Pomona California USA
- Transplant Research Institute; Los Angeles California USA
- St. Vincent Medical Center; Los Angeles California USA
- University of Southern California; Los Angeles California USA
| | - J. Ansari
- Western University of Health Sciences; Pomona California USA
| | - P. Sakharkar
- Roosevelt University College of Pharmacy; Schaumburg Illinois USA
| | - Q. Yasir
- Roosevelt University College of Pharmacy; Schaumburg Illinois USA
| | - R. Naraghi
- Transplant Research Institute; Los Angeles California USA
- St. Vincent Medical Center; Los Angeles California USA
| | - I. Hutchinson
- Mendez National Institute of Transplantation; Los Angeles California USA
- University of Southern California; Los Angeles California USA
| | - D. Min
- Western University of Health Sciences; Pomona California USA
- St. Vincent Medical Center; Los Angeles California USA
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Hadadi A, Jafari S, Jebeli ZH, Hamidian R. Frequncy and etiology of lymphadenopathy in Iranian HIV/AIDS patients. Asian Pac J Trop Biomed 2014; 4:S171-6. [PMID: 25183076 DOI: 10.12980/apjtb.4.2014c1253] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 03/02/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To estimate and outline the frequency and etiology of lymphadenopathy in HIV/AIDS patients. METHODS This study was conducted on 178 consecutive HIV/AIDS patient files for etiologies (categorized into three sub-groups: definite, probable and possible) and associated factors of local and generalized lymphadenopathy. RESULTS Seventy-two (40.45%) patients including 63 male patients (87.5%) developed lymphadenopathy. HIV in lymphadenopathy(+) patients was most commonly transmitted intravenously (n=49). Generalized and localized lymphadenopathy respectively occurred in 27 (37.50%) and 45 (62.50%) patients, mainly in the cervical region (28.9% for local and 63% for generalized lymphadenopathy). The most common causes of lymphadenopathy were tuberculosis (n=24, 33.3%) and lymphoma (n=12, 16.6%). The frequency of lymphadenopathy was non-significantly higher in patients with AIDS (CD4 count <200 cell/µL) vs. HIV(+) patients (CD4 count >200 cell/µL). CONCLUSIONS Lymphadenopathy in HIV/AIDS patients may reflect a serious condition, most likely tuberculosis and lymphoma. Since patients might underestimate lymphadenopathy, physicians would rather list these entities for diagnosis.
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Affiliation(s)
- Azar Hadadi
- Iranian Research Center for HIV/AIDS Institute of High Risk Behavior Reduction, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran ; Internal Medicine Department & Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sirous Jafari
- Infectious Diseases Department and Iranian Research Center for HIV/AIDS, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Reza Hamidian
- Research Development Center, Sina hospital, Tehran University of Medical Sciences, Tehran, Iran
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Keskar V, Jamale T, Karegar M, Parikh H, Jawale S, Mahajan D, Hase N. Late-Onset Cytomegalovirus Gastritis in Low-Risk Renal Allograft Recipients. EXP CLIN TRANSPLANT 2014; 13:279-82. [PMID: 25019524 DOI: 10.6002/ect.2013.0301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Skin grafting has been evolving as an important application in reconstructive surgery. Mixed reports about the survival of allogeneic and xenogeneic keratinocytes require further substantiation to determine the role of these cells in wound healing. MATERIALS AND METHODS Rabbit and rat skins were recovered and cultured in vitro. Full-thickness wounds were created on the dorsum of rabbits (2 cm × 2 cm; n = 4). Cultured epithelial autograft, allograft, and xenograft cells were sprayed onto 3 freshly created wounds, with 1 wound acting as a control. The wounds were monitored every 2 days for 4 weeks. After 4 weeks, the rabbits were killed; skin biopsies were taken from each healed wound and stained with hematoxylin and eosin, and epidermal thickness was measured. RESULTS All examined grafts showed favorable healing outcomes because the wounds appeared similar to normal skin upon healing. The only observed significant difference was the thickness of the epidermis layer, which was thinner in the xenograft (P = .002) than the autograft or allograft. Morphologic evaluation of the skin surface showed that the rat skin was thinner than the rabbit skin. The graft that achieved the best result was the autograft because the thickness was similar to and mimicked normal skin. CONCLUSIONS All 3 grafts (autograft, allograft, and xenograft) have the potential to reconstitute epithelial defects. This approach can overcome the limitation of autologous skin donor sites, especially in burn cases.
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Affiliation(s)
- Vaibhav Keskar
- From the Department of Nephrology, Seth G. S. Medical College and K. E. M. Hospital, Acharya Donde Marg, Parel, Mumbai, Maharashtra, India
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Abstract
The enduring success of lung transplantation is built on the use of immunosuppressive drugs to stop the immune system from rejecting the newly transplanted lung allograft. Most patients receive a triple-drug maintenance immunosuppressive regimen consisting of a calcineurin inhibitor, an antiproliferative and corticosteroids. Induction therapy with either an antilymphocyte monoclonal or an interleukin-2 receptor antagonist are prescribed by many centres aiming to achieve rapid inhibition of recently activated and potentially alloreactive T lymphocytes. Despite this generic approach acute rejection episodes remain common, mandating further fine-tuning and augmentation of the immunosuppressive regimen. While there has been a trend away from cyclosporine and azathioprine towards a preference for tacrolimus and mycophenolate mofetil, this has not translated into significant protection from the development of chronic lung allograft dysfunction, the main barrier to the long-term success of lung transplantation. This article reviews the problem of lung allograft rejection and the evidence for immunosuppressive regimens used both in the short- and long-term in patients undergoing lung transplantation.
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Meije Y, Fortún J, Len Ó, Aguado JM, Moreno A, Cisneros JM, Gurguí M, Carratalà J, Muñoz P, Montejo M, Blanes M, Bou G, Pérez JL, Torre-Cisneros J, Ramos A, Pahissa A, Gavaldà J. Prevention strategies for cytomegalovirus disease and long-term outcomes in the high-risk transplant patient (D+/R-): experience from the RESITRA-REIPI cohort. Transpl Infect Dis 2014; 16:387-96. [PMID: 24807640 DOI: 10.1111/tid.12226] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/27/2013] [Accepted: 01/20/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV)-negative recipients of a graft from a CMV-positive donor (D+/R-) are at high risk of CMV disease. Current preventive strategies include universal prophylaxis (UP) and preemptive therapy (PT). However, the best strategy to prevent CMV disease and achieve better long-term outcomes remains a matter of debate. METHODS We analyzed the incidence of CMV disease and long-term outcomes including graft dysfunction and patient mortality at 5 years after transplantation with both preventive strategies. High-risk (D+/R-) kidney and liver transplant recipients from the RESITRA cohort were included. RESULTS Of 2410 kidney or liver transplant patients, 195 (8.3%) were D+/R-. The final cohort included 58 liver and 102 kidney recipients. UP was given in 92 patients and 68 received PT; 10.9% and 36.8% developed CMV disease, respectively (P < 0.01). The independent risk factors for CMV disease were PT strategy (hazard ratio [HR], 3.30; 95% confidence interval [CI], 1.6-6.9), kidney transplantation (HR, 3.8; 95% CI, 1.4-9.9), and cyclosporine immunosuppression (HR, 2.4; 95% CI, 1.2-4.7). PT strategy was also a risk factor for CMV disease in both liver transplantation (HR, 11.0; 95% CI, 1.2-98.7) and kidney transplantation (HR, 2.7; 95% CI, 1.3-6.0), independently. The development of CMV replication during the first 2 years after transplantation was a risk factor for graft dysfunction at 5 years after transplantation (odds ratio, 3.4; 95% CI, 1.3-9.0). Nevertheless, no significant differences were seen in either graft dysfunction or mortality between the 2 strategies. CONCLUSIONS The study supports the benefit of the UP strategy to prevent CMV disease in D+/R- liver or kidney transplant patients. The development of CMV replication during the first 2 years after transplantation was associated with graft dysfunction at 5 years after transplantation.
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Affiliation(s)
- Y Meije
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Lúcia M, Crespo E, Cruzado JM, Grinyó JM, Bestard O. Human CMV-specific T-cell responses in kidney transplantation; toward changing current risk-stratification paradigm. Transpl Int 2014; 27:643-56. [DOI: 10.1111/tri.12318] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/07/2014] [Accepted: 03/11/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Marc Lúcia
- Experimental Nephrology Laboratory; IDIBELL; Barcelona Spain
| | - Elena Crespo
- Experimental Nephrology Laboratory; IDIBELL; Barcelona Spain
| | - Josep M. Cruzado
- Experimental Nephrology Laboratory; IDIBELL; Barcelona Spain
- Renal Transplant Unit; Nephrology Department; Bellvitge University Hospital; Barcelona Spain
| | - Josep M. Grinyó
- Experimental Nephrology Laboratory; IDIBELL; Barcelona Spain
- Renal Transplant Unit; Nephrology Department; Bellvitge University Hospital; Barcelona Spain
| | - Oriol Bestard
- Experimental Nephrology Laboratory; IDIBELL; Barcelona Spain
- Renal Transplant Unit; Nephrology Department; Bellvitge University Hospital; Barcelona Spain
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