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cytomegalovirus and kidney

Hong Si Nga, Luis Gustavo Modelli Andrade, Mariana Moraes Contti, Mariana Farina Valiatti, Maryanne Machado da Silva, Henrique Mochida Takase
INTRODUCTION: The progress in kidney transplantation has been evident over the years, as well as its benefits for patients. OBJECTIVES: To evaluate the 1.000 kidney transplants performed at the Botucatu Medical School University Hospital, subdividing the patients in different periods, according to the current immunosuppression, and evaluating the differences in graft and patient survival. METHODS: Retrospective cohort analysis of the transplants performed between 06/17/87 to 07/31/16, totaling 1,046 transplants, subdivided into four different periods: 1) 1987 to 2000: cyclosporine with azathioprine; 2) 2001 to 2006: cyclosporine with mycophenolate; 3) 2007 to 2014: tacrolimus with antimetabolic; and 4) 2015 to 2016: tacrolimus with antimetabolic, with increased use of the combination of tacrolimus and mTOR inhibitors...
June 4, 2018: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
Vincent C Emery
Vaccination against cytomegalovirus (CMV), especially in patients undergoing kidney transplantation, has been a subject of investigation since the pioneering studies of Plotkin and colleagues in the 1980s (1). These studies used the Towne strain of CMV in high risk D+R- patients and showed a reduction in severity of symptoms but no overall effect on virus replication (as judged by what we now consider "old" and insensitive assays)(2). We have come a long way since these studies with the advent of sophisticated molecular technologies to create novel vaccine delivery vehicles, highly reproducible and sensitive quantitative assays to assess virus replication and state-of the art immunological assays especially in the context of T-cell responses...
June 12, 2018: American Journal of Transplantation
Corentin Tanné, Pascal Roy, Émilie Frobert, Anita Duncan, Audrey Laurent, Pierre Cochat
Cytomegalovirus is common in adult recipients (prevalence of 40-90%). Children are typically seronegative but immunosuppression may prone to primary-infection or viral reactivation, with potentially severe consequences. CMV infection incidence in pediatric kidney transplant recipients has seldom been investigated. The aim of our study was to evaluate the incidence and timing of CMV infection during the first year after renal transplantation. We assembled a retrospective cohort of 136 children who had received a kidney transplant between 2003 and 2014 with a year follow-up...
June 7, 2018: Néphrologie & Thérapeutique
Demet Demirkol, Umay Kavgacı, Burcu Babaoğlu, Serhan Tanju, Banu Oflaz Sözmen, Suda Tekin
BACKGROUND: The aim of this case report is to discuss diagnostic workup and clinical management of cytomegalovirus reactivation in a critically ill immunocompetent pediatric patient. CASE PRESENTATION: A 2-year-old white boy who had no medical history presented with respiratory distress and fever. His Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores were 20 and 11, respectively. Our preliminary diagnosis was multiple organ dysfunction secondary to sepsis...
June 11, 2018: Journal of Medical Case Reports
Jun Li, Martina Koch, Kathrin Kramer, Katja Kloth, Abd El Rahman Abu Ganim, Silke Scheidat, Franz Rinninger, Friedrich Thaiss, Amit Gulati, Uta Herden, Eike Achilles, Lutz Fischer, Bjoern Nashan
BACKGROUND: To be an optimal immunosuppressive regimen after simultaneous pancreas kidney transplantation (SPK), low dose calcineurin inhibitor and early withdrawal of corticosteroids are desired. METHODS: Immunosuppressive regimen as such has been conducted consecutively in SPK recipients since 2009 in authors' institute. In addition to tacrolimus in low trough level and early corticosteroid withdraw, dual induction with basiliximab and low-dose thymoglobulin in combination with everolimus are the important components of the protocol...
June 6, 2018: Transplant Immunology
H Lee, S Lee, J S Jeon, S H Kwon, H Noh, D C Han, S Yun, D Song
BACKGROUND: The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend that T-cell-depleting agents should be used only for kidney transplant (KT) recipients at high immunologic risk. However, the effects of thymoglobulin induction therapy in low-immunologic risk KT recipients on tacrolimus, mycophenolic acid, and steroid have not been elucidated yet. METHODS: We retrospectively collected 6 months postoperative clinical data, for low-immunologic risk KT recipients at Soonchunhyang University Hospital...
June 2018: Transplantation Proceedings
Chung Hee Baek, Hyosang Kim, Won Seok Yang, Duck Jong Han, Su-Kil Park
AIM: ABO-incompatible (ABOi) kidney transplantation (KT) has become a routine procedure with graft survival rates comparable to those of ABO-compatible KT. However, the clinical significance of the isoagglutinin titer in ABOi KT remains uncertain. Therefore, in this study, we analyzed the clinical outcomes of ABOi KT according to the baseline and postoperative isoagglutinin titer. METHODS: All patients who received ABOi KT between 2009 and 2013 were reviewed and followed up until December 2016...
June 7, 2018: Nephrology
S D Hwang, J H Lee, S W Lee, J K Kim, M-J Kim, J H Song
BACKGROUND: Valganciclovir is widely used to prevent post-transplant cytomegalovirus (CMV) infection in kidney transplant patients. However, the currently used dose remains controversial because the continuous use of this drug decreases kidney function and can induce leukopenia. OBJECTIVE: The purpose of this study was to measure the appropriate dose of valganciclovir required to prevent CMV infection. METHODS: A systematic review and meta-analysis were performed by using a random effects model...
June 2, 2018: Transplantation Proceedings
Hana Rohn, Rafael Tomoya Michita, Esther Schwich, Sebastian Dolff, Anja Gäckler, Mirko Trilling, Vu Thuy Khanh Le-Trilling, Benjamin Wilde, Johannes Korth, Falko M Heinemann, Peter A Horn, Andreas Kribben, Oliver Witzke, Vera Rebmann
The interaction of major histocompatibility complex class I chain-related protein A (MICA) and its cognate activating receptor natural killer (NK) group 2 member D (NKG2D) receptor plays a significant role in viral immune control. In the context of kidney transplantation (KTx), cytomegalovirus (CMV) frequently causes severe complications. Hypothesizing that functional polymorphisms of the MICA/NKG2D axis might affect antiviral NK and T cell responses to CMV, we explored the association of the MICA-129 Met/Val single nucleotide polymorphism (SNP) (affecting the binding affinity of MICA with the NKG2D receptor), the MICA rs2596538 G/A SNP (influencing MICA transcription), and the NKG2D rs1049174 G/C SNP (determining the cytotoxic potential of effector cells) with the clinical outcome of CMV during the first year after KTx in a cohort of 181 kidney donor-recipients pairs...
2018: Frontiers in Immunology
Taeeun Kim, Hyun-Jeong Lee, Sun-Mi Kim, Joo Hee Jung, Sung Shin, Young-Hoon Kim, Heungsup Sung, Yong Pil Chong, Sang-Oh Lee, Sang-Ho Choi, Yang Soo Kim, Jun Hee Woo, Sung-Han Kim, Duck Jong Han
Background/Aims: We evaluated the usefulness in kidney transplant (KT) candidates of cytomegalovirus (CMV)-specific enzyme-linked immunospot (ELISPOT) assays for predicting the development of post-transplant CMV infections. Methods: All adult recipients admitted for living-donor KT between March 2014 and March 2015 were prospectively enrolled except donor CMV-seropositive and recipient seronegative (D+/R-) recipients. All the enrolled patients underwent CMV-specific ELISPOT assays before transplant, and a researcher blinded to the results of these assays examined the patients for CMV infection at least 6 months post-transplant...
June 7, 2018: Korean Journal of Internal Medicine
Mario Fernández-Ruiz, Estela Giménez, Víctor Vinuesa, Tamara Ruiz-Merlo, Patricia Parra, Paula Amat, Miguel Montejo, Aurora Paez-Vega, Sara Cantisán, Julián Torre-Cisneros, Jesús Fortún, Amado Andrés, Rafael San Juan, Francisco López-Medrano, David Navarro, José María Aguado
OBJECTIVE: Previous studies on monitoring of post-transplant cytomegalovirus (CMV)-specific cell-mediated immunity (CMI) are limited by single-center designs and disparate risk categories. We aimed to assess the clinical value of a regular monitoring strategy in a large multicenter cohort of intermediate-risk kidney transplant (KT) recipients. METHODS: We recruited 124 CMV-seropositive KT recipients with no T-cell-depleting induction preemptively managed at four Spanish institutions...
May 24, 2018: Clinical Microbiology and Infection
Geovana Basso, Claudia Rosso Felipe, Marina Pontello Cristelli, Juliana Mansur Siliano, Laila Viana, Alexandra Nicolau Ferreira Brigido, Suelen Bianca Stopa Martins, Daniel Wagner de Castro Lima Santos, Wilson Ferreira Aguiar, Helio Tedesco-Silva Junior, Jose Osmar Medina-Pestana
The use of mTOR inhibitors is associated with lower incidence of CMV infections but its effect on viral load has not been investigated. This post-hoc analysis included data from 273 CMV seropositive kidney transplant recipients randomized to receive anti-thymocyte globulin and everolimus (rAGT/TAC/EVR, n=81), basiliximab and everolimus (BAS/TAC/EVR, n=97) or basiliximab and mycophenolate (BAS/TAC/MPS, n=95). All patients received tacrolimus (TAC) and corticosteroids. Preemptive CMV therapy based on weekly pp65 antigenemia test was used during the first 6 months...
May 24, 2018: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Daniele Lilleri, Paola Zelini, Chiara Fornara, Federica Zavaglio, Teresa Rampino, Laurent Perez, Elisa Gabanti, Giuseppe Gerna
Immune correlates of protection against human cytomegalovirus (HCMV) infection are still debated. This study aimed to investigate which arm of the immune response plays a major role in protection against HCMV infection in kidney (KTR, n=40) and heart transplant recipients (HTR, n= 12). Overall, patients were divided into two groups: one including 37 patients with low viral load (LVL), and the other including 15 patients with high viral load (HVL). All LVL patients resolved the infection spontaneously, whereas HVL patients were all treated with one or more courses of antivirals...
May 24, 2018: Journal of Medical Virology
Katia Lino, Natalia Trizzotti, Fabiana Rabe Carvalho, Rachel Ingrid Cosendey, Cintia Fernandes Souza, Evandro Mendes Klumb, Andrea Alice Silva, Jorge Reis Almeida
INTRODUCTION: In contrast to organ transplantation, few studies correlate the monitoring of pp65 antigenemia with a diagnosis of cytomegalovirus (CMV) in patients with systemic lupus erythematosus (SLE). OBJECTIVE: To highlight the importance of CMV outside transplantation, we monitored pp65 antigenemia in a series of SLE patients. METHODS: From March 2015 to March 2016, SLE patients presenting kidney involvement, fever, and an unclear infection at hospital admission were monitored through pp65 antigenemia...
January 2018: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
Aurora Páez-Vega, Antonio Poyato, Alberto Rodriguez-Benot, Lluis Guirado, Jesús Fortún, Oscar Len, Edson Abdala, María C Fariñas, Elisa Cordero, Carmen de Gracia, Domingo Hernández, Rafael González, Julián Torre-Cisneros, Sara Cantisán
This prospective study evaluates whether CMV-seropositive (R+) transplant patients with pretransplant CD8+IFNG+ T-cell response to cytomegalovirus (CMV) (CD8+IFNG+ response) can spontaneously clear the CMV viral load without requiring treatment. A total of 104 transplant patients (kidney/liver) with pretransplant CD8+IFNG+ response were evaluable. This response was determined using QuantiFERON-CMV assay. The incidence of CMV replication and disease was 45.2% (47/104) and 6.7% (7/104), respectively. Of the total patients, 77...
May 18, 2018: Antiviral Research
Thomas Jouve, Johan Noble, Lionel Rostaing, Paolo Malvezzi
BACKGROUND: The prevalence of end-stage renal disease is increasing worldwide. The best treatment is kidney transplantation, although life-long immunosuppressive therapy is then mandatory. Currently, the cornerstone immunosuppressive therapy relies on tacrolimus, a calcineurin inhibitor that is nephrotoxic but whose exposition can be minimized in a delicate balance. Area covered: We addressed whether, in the setting of kidney transplantation, tacrolimus-based therapy can be tailored to medical needs: to achieve this, we searched for suitable articles in PubMed...
May 19, 2018: Expert Review of Clinical Pharmacology
Dorotéa de Fátima Lobato da Silva, Jedson Ferreira Cardoso, Sandro Patroca da Silva, Leda Mani França Arruda, Renato Lopes Fernandes de Medeiros, Marluce Matos Moraes, Rita Catarina Medeiros Sousa
INTRODUCTION: Human cytomegalovirus is one of the causes of opportunist infections in immunocompromised patients, and is triggered by factors such as state of viral latency, weakened immune responses, and development of antiviral resistance to ganciclovir, the only drug offered by the public health system in Brazil to treat the infection. The goal of this study was to identify mutations that may be associated with antiviral resistance in immunocompromised patients. METHODS: Molecular analysis was performed in 82 blood samples and subjected to genomic DNA extraction by a silica-based method...
March 2018: Revista da Sociedade Brasileira de Medicina Tropical
Rachel M Engen, Meei-Li Huang, Giulia E Park, Jodi M Smith, Ajit P Limaye
BACKGROUND: Adenovirus infection is associated with graft dysfunction and graft loss in pediatric cardiac, lung, and liver transplants in prior retrospective studies, but data in pediatric kidney transplant recipients is limited. METHODS: We conducted a prospective single-center cohort study of 75 consecutive pediatric kidney transplant recipients who underwent monthly screening for adenovirus viremia and symptom assessment for 2 years posttransplant. RESULTS: Adenovirus viremia was detected in 11 (14...
May 2, 2018: Transplantation
Merve Postalcioglu, Haesook T Kim, Faruk Obut, Osman Arif Yilmam, Jiqiao Yang, Benjamin C Byun, Sophie Kupiec-Weglinski, Robert Soiffer, Jerome Ritz, Joseph H Antin, Edwin Alyea, John Koreth, Corey Cutler, Philippe Armand, Julie M Paik, David E Leaf, Vincent T Ho, Reza Abdi
Transplantation-associated thrombotic microangiopathy (TA-TMA) is a serious complication of hematopoietic stem cell transplantation (HSCT). We characterized the incidence, risk factors, and long-term outcomes associated with TA-TMA by performing a comprehensive review of all adult patients (n=1,990) undergoing allogeneic HSCT at the Dana Farber Cancer Institute/Brigham and Women's Hospital between 2005 and 2013. Using the City of Hope criteria, we identified 258 (13%) and 508 (26%) patients with "definite" and "probable" TMA, respectively...
May 11, 2018: Biology of Blood and Marrow Transplantation
Johan Noble, Thomas Jouve, Lionel Rostaing, Paolo Malvezzi
Cornerstone immunosuppressive therapy currently relies on immediate-release tacrolimus, a calcineurin inhibitor (CNI) that is potentially nephrotoxic and is more diabetogenic than cyclosporine A. Two new formulations of tacrolimus have been launched: an extended-release formulation (Advagraf®/Astagraf XL®, Astellas company) and a long-lasting formulation (Envarsus®, Veloxis company). Area covered: Herein, we assess the efficacy of an extended-release formulation of tacrolimus (Advagraf®/Astagraf XL®) used in conjunction with or without an induction therapy (i...
May 14, 2018: Expert Review of Clinical Immunology
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