title: Effects of Granulocyte and Monocyte Adsorptive Apheresis in Renal Transplantation Recipients With Concomitant Cytomegalovirus Infection.
abstract: BACKGROUND
  Granulocyte and monocyte adsorptive apheresis (GMAA) is widely used as a treatment for active ulcerative colitis (UC) in Japan. Much attention has been paid to the possibility of GMAA for the treatment and control of cytomegalovirus (CMV) reactivation in patients with refractory UC and concomitant CMV infection. In this study, the effects of the combination of GMAA and antiviral therapy were examined in renal transplant recipients with concomitant CMV infection.
  
  
  METHODS
  Combination therapy of GMAA and antiviral drugs was performed 9 times in 7 renal transplant recipients with concomitant CMV infection. Four of the cases were positive for CMV-IgG, and 3 were negative. The clinical presentation of CMV infection was viremia in 6 cases and disease (CMV retinitis) in 1 case. CMV infection was diagnosed by using an antigenemia assay (C7-HRP). GMAA session was performed once, and the duration of the session was 120 min. Immediately after the GMAA session, ganciclovir was administered at 5 mg/kg/body weight. CMV infection was monitored based on C7-HRP and CMV-DNA in the peripheral blood samples.
  
  
  RESULTS
  All cases became negative for C7-HRP and CMV-DNA within 21 days (median, 14 days; range, 3-21 days) and 17 days (median, 6 days; range, 3-17 days), respectively, after starting the combination therapy. No side effects of GMAA were observed.
  
  
  CONCLUSIONS
  This case series found that GMAA in combination with antiviral drugs may shorten the duration of treatment against CMV infection in renal transplant recipients. Further studies in a larger number of patients are required to confirm these results.
authors.affiliation: Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan. Electronic address: spxd48k9@aria.ocn.ne.jp.
authors.forename: T
authors.initials: T
authors.lastname: Naganuma
authors.affiliation: Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Takemoto
authors.affiliation: Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Iwai
authors.affiliation: Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Kuwabara
authors.affiliation: Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Uchida
authors.affiliation: Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nakatani
authors.affiliation: Department of Artificial Kidney, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Kitamura
authors.affiliation: Department of Artificial Kidney, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Masuda
authors.affiliation: Department of Clinical Laboratory, Graduate School of Medicine, Kyoto University Hospital, Kyoto, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Ohmori
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University Hospital, Kyoto, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Matsuura
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University Hospital, Kyoto, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Nakase
mesh_terms: D000327:Adsorption; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D001781:Blood Component Removal; D003131:Combined Modality Therapy; D003586:Cytomegalovirus Infections / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006098:Granulocytes; D006801:Humans; D007564:Japan; D007676:Kidney Failure, Chronic / Q000601:surgery / Q000821:virology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009000:Monocytes
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir