RESUMO
Every year the number of patients waiting for a heart transplant increases faster than the number of available donor organs. Some potential donor organs are from donors with active communicable diseases, including hepatitis C virus (HCV), potentially making donation prohibitive. The advent of direct-acting antiviral agents for HCV has drastically changed the treatment of HCV. Recently, these agents have been used to treat HCV in organ donor recipients who acquired the disease from the donor organ. We report a case of heart-kidney transplantation from an HCV viremic donor to HCV negative recipient with successful treatment and sustained virologic response.
Assuntos
Antivirais/uso terapêutico , Transplante de Coração/efeitos adversos , Hepacivirus/isolamento & purificação , Hepatite C/tratamento farmacológico , Transplante de Rim/efeitos adversos , Doadores Vivos , Viremia/tratamento farmacológico , Aloenxertos/virologia , Função Retardada do Enxerto/terapia , Função Retardada do Enxerto/virologia , Seguimentos , Coração/virologia , Transplante de Coração/métodos , Hepatite C/transmissão , Hepatite C/virologia , Humanos , Rim/virologia , Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Recidiva , Terapia de Substituição Renal , Resultado do Tratamento , Carga Viral , Viremia/transmissão , Viremia/virologiaRESUMO
HHV-6 is an evolving pathogen in the field of AlloHCT. However, the impact of HHV-6 on AlloHCT outcomes remains to be elucidated. We studied the incidence and clinical impact of HHV-6 viremia in children following AlloHCT. One hundred consecutive children were monitored weekly by plasma PCR for the first 180 days following AlloHCT for HHV-6, CMV, EBV, and ADV. HHV-6 viremia was defined as plasma PCR >1000 viral copies/mL. The median age was nine yr. Following AlloHCT, 19% (95% CI 11.3-26.7%) of patients had HHV-6 viremia, with the highest incidence of reactivation (14/19, 73%) occurring during day +15-day +98. The proportion of platelet engraftment by day +180 was lower in patients with HHV-6 viremia (58%) than in those without HHV-6 viremia (82%), p = 0.028. Delay in neutrophil and platelet engraftment was not associated with HHV-6 viremia in multivariate analysis. Similarly, HHV-6 viremia was not associated with TRM in multivariate analysis (p = 0.15). In summary, HHV-6 viremia is prevalent in pediatric AlloHCT recipients. Based on our study results, we recommend that HHV-6 PCR should only be performed on clinical suspicion.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Herpesvirus Humano 6 , Complicações Pós-Operatórias , Infecções por Roseolovirus/etiologia , Viremia/etiologia , Adolescente , Criança , Pré-Escolar , Função Retardada do Enxerto/virologia , Feminino , Herpesvirus Humano 6/isolamento & purificação , Humanos , Incidência , Lactente , Masculino , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Infecções por Roseolovirus/diagnóstico , Infecções por Roseolovirus/epidemiologia , Transplante Homólogo , Viremia/diagnóstico , Viremia/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Information is limited on long-term outcomes after preemptive use of ganciclovir to control cytomegalovirus (CMV) infection in lung transplantation. METHODS: We studied 78 lung recipients who received antithymocyte globulin induction from 1994 to 2000. All patients received six months of oral acyclovir (800 mg TID). This was interrupted three wk post transplantation for a two-wk course of IV ganciclovir. Additional courses of ganciclovir were administered based on serial virological monitoring. CMV-mismatched patients (R-D+) also received four doses of CMV immunoglobulin between weeks 2 and 8. RESULTS: The one yr cumulative risk of CMV disease was 2% (1/61) in CMV seropositive (R+) patients, but was 37% (6/17) in R-D+ patients (p < 0.0001). Over 4.3 yr of follow-up, patients with CMV infection developed more chronic graft dysfunction caused by bronchiolitis obliterans or bronchiolitis obliterans syndrome than patients without CMV infection (p = 0.012). This effect was also apparent in the subgroup of R+ recipients (p = 0.043). Acute rejection and overall survival were not associated with CMV infection. CONCLUSIONS: The use of prophylactic acyclovir and short preemptive courses of ganciclovir effectively controlled CMV disease in R+ patients, but was a relative failure in R-D+ patients. CMV infection was significantly associated with chronic graft dysfunction, even in R+ recipients who had good control of CMV symptoms.
Assuntos
Antivirais/administração & dosagem , Infecções por Citomegalovirus/prevenção & controle , Ganciclovir/administração & dosagem , Transplante de Coração-Pulmão , Aciclovir/administração & dosagem , Adolescente , Adulto , Idoso , Quimioprevenção , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/transmissão , Função Retardada do Enxerto/virologia , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Doadores de Tecidos , Adulto JovemRESUMO
BACKGROUND: Polyomavirus nephropathy (BKVN) is an important cause of chronic allograft dysfunction (CAD). Recipient determinants (male sex, white race, and older age), deceased donation, high-dose immunosuppression, diabetes, delayed graft function (DGF), cytomegalovirus infection, and acute rejection (AR) are risk factors. Reducing immunosuppression is the best strategy in BKVN. The objective of our study was to evaluate CAD progression after therapeutic strategies in BKVN and risk factors for graft loss (GL). METHODS: Retrospective analysis of 23 biopsies, from patients with CAD and histological evidence of BKVN, conducted over a period of 10 years. Glomerular filtration rate was <30 mL/min in 16 patients at the time of the BKVN diagnosis. RESULTS: BKVN was histologically diagnosed in 23 recipients (19 men, 4 women). All patients were white, with age of 51.2 ± 12.1 years (6 patients, age >60 years), and 22 had a deceased donor. Diabetes affected 4 patients, DGF occurred in 3, cytomegalovirus infection in 2, and AR in 15. All patients were medicated with calcineurin inhibitors (CNI) (95.7% tacrolimus) and corticoids, and 16 also received an antimetabolite. One year after antimetabolite reduction/discontinuation and/or CNI reduction/switching and/or antiviral agents, graft function was decreased in 11 patients, increased/stabilized in 10, and unknown in 2. GL occurred in 9 patients. Older age (hazard ratio, 1.76; 95% confidence interval, 0.94-3.28) and DGF (hazard ratio, 2.60; 95% confidence interval, 0.54-12.64) were the main risk factors for GL. The lower GFR at the time of the BKVN diagnosis was associated with an increased risk of initiation of dialysis. CONCLUSIONS: GL occurred in 39.1% of patients with BKVN and DGF; older age and lower GFR at the time of diagnosis were important risk factors. Early diagnosis of BKVN is essential to prevent GL.
Assuntos
Inibidores de Calcineurina/efeitos adversos , Terapia de Imunossupressão/efeitos adversos , Nefropatias/virologia , Transplante de Rim/efeitos adversos , Infecções por Polyomavirus/complicações , Complicações Pós-Operatórias/virologia , Adulto , Aloenxertos/virologia , Vírus BK , Função Retardada do Enxerto/virologia , Progressão da Doença , Feminino , Taxa de Filtração Glomerular , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Polyomavirus , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Tacrolimo/efeitos adversos , Fatores de TempoRESUMO
BACKGROUND: With the introduction of the Kidney Allocation System in the United States in December 2014, transplant centers can list eligible B blood type recipients for A2 organ offers. There have been no prior reports of ABO incompatible A2 to B deceased donor kidney transplantation in human immunodeficiency virus-positive (HIV+) recipients to guide clinicians on enrolling or performing A2 to B transplantations in HIV+ candidates. We are the first to report a case of A2 to B deceased donor kidney transplantation in an HIV+ recipient with good intermediate-term results. METHODS AND RESULTS: We describe an HIV+ 39-year-old African American man with end-stage renal disease who underwent A2 to B blood type incompatible deceased donor kidney transplantation. Prior to transplantation, he had an undetectable HIV viral load. The patient was unsensitized, with his most recent anti-A titer data being 1:2 IgG and 1:32 IgG/IgM. Induction therapy of basiliximab and methylprednisolone was followed by a postoperative regimen of plasma exchange, intravenous immunoglobulin, and rituximab with maintenance on tacrolimus, mycophenolate mofetil, and prednisone. He had delayed graft function without rejection on allograft biopsy. Nadir serum creatinine was 2.0 mg/dL. He continued to have an undetectable viral load on the same antiretroviral therapy adjusted for renal function. CONCLUSIONS: To our knowledge, this is the first report of A2 to B deceased donor kidney transplantation in an HIV+ recipient with good intermediate-term results, suggesting that A2 donor kidneys may be considered for transplantation into HIV+ B-blood type wait list candidates.
Assuntos
Sistema ABO de Grupos Sanguíneos , Incompatibilidade de Grupos Sanguíneos , Infecções por HIV/sangue , Falência Renal Crônica/sangue , Transplante de Rim/métodos , Adulto , Função Retardada do Enxerto/sangue , Função Retardada do Enxerto/virologia , Infecções por HIV/cirurgia , Infecções por HIV/virologia , Humanos , Falência Renal Crônica/cirurgia , Falência Renal Crônica/virologia , Masculino , Doadores de Tecidos , Resultado do TratamentoRESUMO
Polyomavirus mediated nephropathy is an increasingly recognized complication in renal transplant recipients. In all, 362 renal biopsies collected from 15 European transplant centers were analyzed for presence of Polyomavirus nucleic acid (BK virus [BKV] and JC virus [JCV]). We evaluated 302 biopsies of patients with renal allograft dysfunction, including three with known BKV allograft nephropathy (BKVAN), and 60 native kidney biopsies. BKV DNA was detected in 8 of the 302 (2.6 %) biopsies obtained for transplant dysfunction, but in none of the controls. BKV RNA, indicating active viral replication, was found in all BKV DNA positive biopsies available for mRNA expression studies. Retrospective immunohistochemical staining was positive for SV40 large T antigen in all seven evaluated biopsies. BKV DNA and RNA were detected in biopsy tissues from patients with inconspicuous light microscopy for BKVAN. Further studies will evaluate the potential of intrarenal viral BKV RNA as an early predictor for BKVAN.
Assuntos
Função Retardada do Enxerto/virologia , Transplante de Rim , Infecções por Polyomavirus/patologia , Polyomavirus/isolamento & purificação , Infecções Tumorais por Vírus/patologia , Adulto , Idoso , Biópsia , DNA Viral/análise , Função Retardada do Enxerto/patologia , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polyomavirus/genética , Infecções por Polyomavirus/complicações , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/virologia , RNA Viral/análise , Estudos Retrospectivos , Transplante Homólogo , Infecções Tumorais por Vírus/complicaçõesRESUMO
BACKGROUND: Polyomavirus BK (BKV) is currently considered one of the most important infectious diseases in kidney transplants recipients. The prevalence of decoy cells (viral containing shed urothelial cells) in these patients varies between 20% and 60%. Of decoy-positive patients, 1%-8% develop BKV nephropathy, a finding that may be associated with graft failure in up to 80% of affected individuals. METHODS: Decoy cells cytology is an easily performed and inexpensive assay useful for poliomavirus infection screening. Data on the prevalence of decoy cells in simultaneous pancreas-kidney or isolated pancreas recipients remains largely unreported. In the present study, we evaluated 221 patients ≥18 years old with >1 month follow-up after transplantation who had attended the outpatient clinic between September and December 2006. RESULTS: The total prevalence of decoy cells was 16% (16.9% in kidney recipients, 5.9% in simultaneous kidney-pancreas recipients and 20% in pancreas alone recipients). There were no differences between patients with either positive or negative urinary cytology for decoy cells, regarding demographic (gender, age, race) or clinical (time posttransplantation, donor type [deceased vs living donation], and presence of delayed graft function or rejection, other associated viral infections and type of immunosuppressive drugs variables.