E Hryniewiecka1, D Sołdacki2, L Pączek2. 1. Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland. Electronic address: elhryniewiecka@gmail.com. 2. Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
Abstract
BACKGROUND: Despite advances in immunosuppressive therapy and post-transplantation care, antiviral prevention, and therapy, cytomegalovirus (CMV) infection remains the most common viral infection after solid organ transplantation (SOT). METHODS: This study included 2,375 patients under the care of our transplant center during the 1-year period from June 2012 to June 2013. There were 351 patients (14.78%) suspected and tested for CMV infection with the use of viral DNA amplification test. RESULTS: Symptoms that triggered diagnostics were graft dysfunction in 24 (55.8%), diarrhea in 18 (41.9%), fever in 15 (34.9%), leukopenia in 14 (32.6%), abdominal pain in 13 (30.2%), nausea in 7 (16.3%), cough in 6 (14%), and shivers in 2 (4.7%). Positive test results were obtained in 43 patients (12.3% of patients tested and 1.8% of the entire cohort). The group consisted of 17 women (39.5%) and 26 men (60.5%), 26 kidney (60.5%) and 17 liver (39.5%) transplant recipients, aged 49.3 years (SD 14.9). The initial viral load was median 8,093 (range: 4,232-219,180) copies/mL. The mean ganciclovir (GCV) treatment duration was 19.05 (SD 8.1) days. GCV doses ranged from 100 to 1,000 mg/d, mean 370.6 (SD 254.2) mg/d. Clinical resistance to treatment was diagnosed in 5 patients (11.6%). We found a positive correlation of GCV treatment duration with natural logarithm of initial CMV viremia (r = 0.56; P = .0002) and of time in months to CMV infection with mean cyclosporine level (r = -0.74; P = .04) and GCV dose (r = -0.34; P = .03). The duration of GCV therapy was positively influenced by CMV load and tacrolimus administration and negatively by patient's age and male sex. CONCLUSIONS: Appearance of any symptoms occurring after transplantation, even nonspecific, should lead to diagnostics for CMV infection. The duration of treatment depends on the severity of the infection expressed by CMV viremia. Clinical resistance to GCV is not frequent, but it is an important transplantologic problem.
BACKGROUND: Despite advances in immunosuppressive therapy and post-transplantation care, antiviral prevention, and therapy, cytomegalovirus (CMV) infection remains the most common viral infection after solid organ transplantation (SOT). METHODS: This study included 2,375 patients under the care of our transplant center during the 1-year period from June 2012 to June 2013. There were 351 patients (14.78%) suspected and tested for CMV infection with the use of viral DNA amplification test. RESULTS: Symptoms that triggered diagnostics were graft dysfunction in 24 (55.8%), diarrhea in 18 (41.9%), fever in 15 (34.9%), leukopenia in 14 (32.6%), abdominal pain in 13 (30.2%), nausea in 7 (16.3%), cough in 6 (14%), and shivers in 2 (4.7%). Positive test results were obtained in 43 patients (12.3% of patients tested and 1.8% of the entire cohort). The group consisted of 17 women (39.5%) and 26 men (60.5%), 26 kidney (60.5%) and 17 liver (39.5%) transplant recipients, aged 49.3 years (SD 14.9). The initial viral load was median 8,093 (range: 4,232-219,180) copies/mL. The mean ganciclovir (GCV) treatment duration was 19.05 (SD 8.1) days. GCV doses ranged from 100 to 1,000 mg/d, mean 370.6 (SD 254.2) mg/d. Clinical resistance to treatment was diagnosed in 5 patients (11.6%). We found a positive correlation of GCV treatment duration with natural logarithm of initial CMV viremia (r = 0.56; P = .0002) and of time in months to CMV infection with mean cyclosporine level (r = -0.74; P = .04) and GCV dose (r = -0.34; P = .03). The duration of GCV therapy was positively influenced by CMV load and tacrolimus administration and negatively by patient's age and male sex. CONCLUSIONS: Appearance of any symptoms occurring after transplantation, even nonspecific, should lead to diagnostics for CMV infection. The duration of treatment depends on the severity of the infection expressed by CMV viremia. Clinical resistance to GCV is not frequent, but it is an important transplantologic problem.
Authors: Federico Coccolini; Mario Improta; Massimo Sartelli; Kemal Rasa; Robert Sawyer; Raul Coimbra; Massimo Chiarugi; Andrey Litvin; Timothy Hardcastle; Francesco Forfori; Jean-Louis Vincent; Andreas Hecker; Richard Ten Broek; Luigi Bonavina; Mircea Chirica; Ugo Boggi; Emmanuil Pikoulis; Salomone Di Saverio; Philippe Montravers; Goran Augustin; Dario Tartaglia; Enrico Cicuttin; Camilla Cremonini; Bruno Viaggi; Belinda De Simone; Manu Malbrain; Vishal G Shelat; Paola Fugazzola; Luca Ansaloni; Arda Isik; Ines Rubio; Itani Kamal; Francesco Corradi; Antonio Tarasconi; Stefano Gitto; Mauro Podda; Anastasia Pikoulis; Ari Leppaniemi; Marco Ceresoli; Oreste Romeo; Ernest E Moore; Zaza Demetrashvili; Walter L Biffl; Imitiaz Wani; Matti Tolonen; Therese Duane; Sameer Dhingra; Nicola DeAngelis; Edward Tan; Fikri Abu-Zidan; Carlos Ordonez; Yunfeng Cui; Francesco Labricciosa; Gennaro Perrone; Francesco Di Marzo; Andrew Peitzman; Boris Sakakushev; Michael Sugrue; Marja Boermeester; Ramiro Manzano Nunez; Carlos Augusto Gomes; Miklosh Bala; Yoram Kluger; Fausto Catena Journal: World J Emerg Surg Date: 2021-08-09 Impact factor: 5.469