Cytomegalovirus-related complications in human hand transplantation.
BACKGROUND
Up to date, 24 hands/thumbs have been transplanted in 18 patients. We herein report on cytomegalovirus (CMV) infection, disease, and the adopted treatment.


METHODS
Immunosuppression consisted of tacrolimus-based triple-drug therapy with antithymocyte globuline or CD25-receptor antagonist induction. Donor/recipient CMV match was negative/negative (n=8), negative/positive (n=3), positive/positive (n=3), positive/negative (n=3) and unknown in one case. Six patients (three +/-, two +/+, and one -/+) received gancyclovir i.v. followed by oral gancyclovir or valgancyclovir for prophylaxis.


RESULTS
Patient and graft survival at a mean follow-up of 42.9 months were 100% and 91%, respectively. Of all patients tested for CMV, 45.5% developed CMV infection or disease. Two patients that were given a CMV-positive graft showed very high viral loads (550 and 1200/200000 leukocytes) after transplantation. Gancyclovir treatment failed to permanently control CMV in 80% of the patients experiencing CMV infection. Those patients requiring more toxic second-line therapies (foscarnet/cidofovir) suffered from side effects such as nephrotoxicity, nausea, vomiting, and diarrhea.


CONCLUSIONS
CMV infection/disease complicated the postoperative course after composite tissue allograft (CTA) transplantation in five of nine recipients challenged with the virus. The close time correlation suggests an association between virus replication and rejection in some cases. CMV represents the major infectious threat in CTA transplantation. Therefore, CMV-mismatch should be avoided and prophylaxis with valgancyclovir and anti-CMV hyperimmunoglobulin should be mandatory.
Schneeberger
Stefan
S
Department of General and Transplant Surgery, Innsbruck Medical University, Innsbruck, Austria.
Lucchina
Stefano
S
Lanzetta
Marco
M
Brandacher
Gerald
G
Bösmüller
Claudia
C
Steurer
Wolfgang
W
Baldanti
Fausto
F
Dezza
Clara
C
Margreiter
Raimund
R
Bonatti
Hugo
H
D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000276:immunology; D000956:Antigens, Viral / Q000276:immunology; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D004279:DNA, Viral / Q000235:genetics; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000627:therapeutic use; D006084:Graft Rejection / Q000473:pathology / Q000517:prevention & control; D006085:Graft Survival; D006230:Hand Injuries / Q000601:surgery; D063987:Hand Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use; D014019:Tissue Donors
D000914:Antibodies, Viral; D000956:Antigens, Viral; D000998:Antiviral Agents; D004279:DNA, Viral; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D015774:Ganciclovir; D016559:Tacrolimus