title: Incidence and outcomes of cytomegalovirus in pancreas transplantation with steroid-free immunosuppression.
abstract: Cytomegalovirus (CMV) is a common opportunistic infection encountered after pancreas transplantation. The records of 407 pancreas transplant recipients (226 simultaneous pancreas and kidney transplant (SPK), 101 pancreas transplant after kidney (PAK), and 97 pancreas transplants alone [PTA]) performed at a single center with at least 1-yr follow-up were reviewed. Immunosuppression included rabbit antithymocyte globulin induction, steroid withdrawal, and maintenance therapy of tacrolimus and sirolimus (± mycophenolate). In addition, PTA recipients received a single dose of rituximab. All recipients received valganciclovir prophylaxis. Donor (D)+/recipient (R)- recipients received 6 months of prophylaxis; all others received 3 months. The overall CMV infection rate was 12%. The cumulative incidences of CMV infection at 3, 6, 9, and 12 months after transplant were 0.25%, 3%, 7%, and 8%, respectively. CMV infection rates were 20.2% in the D+/R- group, 16.5% in the D+/R+ group, 5.0% in the D-/R+ group, and 2.8% in the D-/R- group. Infections were less common in SPK recipients. Most infections developed at least 3 months post-transplant, and 24% demonstrated tissue-invasive disease. Immunosuppression was NOT reduced in 72% of patients with infections. Ganciclovir-resistant CMV occurred in four patients. No patients died or lost their allografts due to CMV-related infection; one graft was lost due to chronic rejection associated with a reduction in immunosuppression. In many cases, CMV infections may be treated in pancreas transplant recipients without necessarily reducing immunosuppression.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Ashesh P
authors.initials: AP
authors.lastname: Shah
authors.affiliation: Department of Pharmacy, Indiana University Health-University Hospital, Indianapolis, IN, USA.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Chen
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Fridell
mesh_terms: D000328:Adult; D000818:Animals; D019072:Antibiotic Prophylaxis; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000472:pathogenicity*; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects*; D011379:Prognosis; D011817:Rabbits; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000998:Antiviral Agents
keywords: cytomegalovirus; immunosuppression; infection; outcomes; pancreas transplantation