Article

Cytomegalic inclusions in pancreatic allograft after simultaneous pancreas-kidney transplantation: case report and literature review

Einstein (Sao Paulo) 12/2008; 6(4):481-484..
Source: DOAJ

ABSTRACT The incidence of cytomegalovirus (CMV) infection has increased inthe past years due to the use of more potent immunosuppressors,such as tacrolimus and mycophenolate. This is related to the earlypost transplantation period, when immunosuppressive regimenis more intense. Other well-known risk factors for CMV infectioninclude the serological status of donor (D) and recipient (R) and theuse of monoclonal or polyclonal antibodies for induction therapy or fortreating acute rejection. In the present study, it was reported a case ofan invasive CMV infection in the parenchyma of pancreatic allograftafter simultaneous pancreas-kidney transplantation. Upon diagnosis ofCMV infection, the patient also presented other clinical complicationsrelated to the transplant, such as bacterial and fungal infection, as wellas enteric fistula. The occurrence of invasive CMV infection is a rareevent, but it should be suspected if high risk factors for this infection arepresent or if there are concomitant clinical or surgical complications.Keywords: Cytomegalovirus infections; Pancreas transplantation;Kidney transplantation; Case reports

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Available from: Erika B Rangel, Jul 04, 2015
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    ABSTRACT: The impact of tacrolimus (TAC), mycophenolate mofetil (MMF) and steroid immunosuppression on cytomegalovirus (CMV) infection in combination with ganciclovir prophylaxis in simultaneous kidney-pancreas transplantation (SKPT) has not been well studied. A retrospective analysis was made of 75 SKPTs performed between 1 January 1996 and 7 January 1999. All patients received ganciclovir for 3 months, but CMV donor (D)+ / recipient (R)- patients received ganciclovir for 6 months. 16/74 (22%) were CMV D+/R-, 25 (33%) D+/R+, 16 (22%) D-/R+, and 17 (23%) D-/R- (1 patient with unknown donor serology was excluded). The mean time to CMV infection was 198 days post-transplant. The incidence of either CMV infection or tissue invasive CMV disease was 16/74 (22%), including 9 (12%) with CMV infection and 7 (10%) CMV disease. The one-year patient, kidney, and pancreas graft survival rates were 91%, 89%, and 83%, respectively. The mean follow-up was 29 months (minimum of 12 months). CMV infection was not associated with an increased incidence of graft failure or mortality. The D+/R- group had the highest incidence of CMV infection (44%) compared with the other serologic groups (17%, P=0.02). Concurrent CMV and rejection occurred more frequently in the D+/R- than the other serologic groups (25% vs. 7%, P=0.03). The D-/R- group had the best outcomes, with no CMV infection, improved kidney graft survival at the end of follow-up (82% vs. 72%, P=0.04) and the highest event-free survival (no CMV infection, rejection, or graft loss) when compared to the other groups (76% vs. 33%, P<0.01). Compared to previous studies, ganciclovir prophylaxis delayed the onset and reduced the severity of CMV infection in patients receiving TAC, MMF, and steroids. Despite ganciclovir prophylaxis, CMV seronegative patients receiving CMV D+ organs had worse outcomes than seronegative recipients receiving CMV D- organs.
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