Cytomegaloviral infection in solid organ transplant recipients: preliminary report of one transplant center experience.
BACKGROUND
Despite advances in immunosuppressive therapy and post-transplantation care, antiviral prevention, and therapy, cytomegalovirus (CMV) infection remains the most common viral infection after solid organ transplantation (SOT).


METHODS
This study included 2,375 patients under the care of our transplant center during the 1-year period from June 2012 to June 2013. There were 351 patients (14.78%) suspected and tested for CMV infection with the use of viral DNA amplification test.


RESULTS
Symptoms that triggered diagnostics were graft dysfunction in 24 (55.8%), diarrhea in 18 (41.9%), fever in 15 (34.9%), leukopenia in 14 (32.6%), abdominal pain in 13 (30.2%), nausea in 7 (16.3%), cough in 6 (14%), and shivers in 2 (4.7%). Positive test results were obtained in 43 patients (12.3% of patients tested and 1.8% of the entire cohort). The group consisted of 17 women (39.5%) and 26 men (60.5%), 26 kidney (60.5%) and 17 liver (39.5%) transplant recipients, aged 49.3 years (SD 14.9). The initial viral load was median 8,093 (range: 4,232-219,180) copies/mL. The mean ganciclovir (GCV) treatment duration was 19.05 (SD 8.1) days. GCV doses ranged from 100 to 1,000 mg/d, mean 370.6 (SD 254.2) mg/d. Clinical resistance to treatment was diagnosed in 5 patients (11.6%). We found a positive correlation of GCV treatment duration with natural logarithm of initial CMV viremia (r = 0.56; P = .0002) and of time in months to CMV infection with mean cyclosporine level (r = -0.74; P = .04) and GCV dose (r = -0.34; P = .03). The duration of GCV therapy was positively influenced by CMV load and tacrolimus administration and negatively by patient's age and male sex.


CONCLUSIONS
Appearance of any symptoms occurring after transplantation, even nonspecific, should lead to diagnostics for CMV infection. The duration of treatment depends on the severity of the infection expressed by CMV viremia. Clinical resistance to GCV is not frequent, but it is an important transplantologic problem.
Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland. Electronic address: elhryniewiecka@gmail.com.
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Hryniewiecka
Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
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Sołdacki
Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
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Pączek
D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007165:Immunosuppression Therapy; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies; D066027:Transplant Recipients; D019562:Viral Load; D014766:Viremia / Q000821:virology
D000998:Antiviral Agents; D015774:Ganciclovir