Senior Registrar in Nephrology, Teaching Hospital Kandy
There are high numbers of post renal transplant patients having infections. Common infections are CMV, BKV, bacterial and fungal infections. So the identification of risk factors of post renal transplantation CMV infection is important to overcome the burden.
Abstract: Cytomegalovirus (CMV) is the most common viral infection after kidney transplantation and is associated with significant morbidity and mortality. Recent studies showed that CMV-specific CD8+ T cells play the crucial role in protection against CMV. The Quantiferon-CMV (QF-CMV) is an interferon gamma (IFN-γ) release assay (IGRA test) that measures the IFN-γ response to a range of T-cell epitopes of CMV. In the present study, we analyzed the clinical utility of QF-CMV assay to predict CMV infection in kidney transplant recipients and evaluated if reactive result in QF-CMV test could be predictor of the duration of treatment. We studied 75 renal transplant recipients who had IGRA testing just before transplantation. The donor and recipient variables were reported from the clinical history. The variables related to transplantation were collected from transplantation process data and included CMV infection or disease, CMV treatment, and immunosuppressive treatment. Laboratory variables were C3-C4 complement fractions and DNA quantification of CMV. Fifty percent of patients had CMV infection, and 35.9% had CMV disease. The time of negativization of CMV DNA was 56.61 ± 23.5 days. Univariate analysis related to CMV infection only showed a statistically significant relation with thymoglobulin treatment (P = .001). Statistically significant variables in relation with CMV infection incidence were donor serology (P = .044) and thymoglobulin treatment (P = .004). The probability of CMV infection was lower with positive IGRA assay (P = .025). We found that IFN-γ response measured by QF-MV is a protective factor against CMV infection in post-transplantation kidney recipients. Copyright © 2017 Elsevier Inc. All rights reserved.
Pub.: 28 Mar '18, Pinned: 24 Apr '18
Abstract: We sought to determine if conversion from tacrolimus/mycophenolate mofetil (TAC-MMF) to tacrolimus/mTOR inhibitor (TAC-mTOR) immunosuppression would reduce the incidences of BK and CMV viremia after kidney/pancreas (KP) transplantation. In this single center review, the TAC-mTOR cohort (n=39) was converted at one month post-transplant to an mTOR inhibitor and reduced dose tacrolimus. Outcomes were compared to a cohort of KP recipients (n=40) maintained on TAC-MMF. At 3-years post-transplant, KP survivals and incidences of kidney/pancreas rejection were equivalent between mTOR and MMF-treated cohorts. (p:ns). BK viremia-free survival was better for the mTOR versus MMF-treated group (p=0.004). In multi-variate analysis, MMF vs. mTOR immunosuppression was an independent risk factor for BK viremia (hazard ratio 12.27, p:0.02). Similarly, mTOR-treated recipients displayed better CMV infection-free survival compared to the MMF-treated cohort (p=0.01). MMF vs. mTOR immunosuppression (hazard ratio 18.77, p:0:001) and older recipient age (hazard ratio1.13 per year, p:0.006,) were independent risk factors for CMV viremia. Mean estimated GFR and HgbA1c levels were equivalent between groups at one, 2, and 3 years post-transplantation. Conversion from TAC/MMF to TAC/mTOR immunosuppression after KP transplantation reduced the incidences of BK and CMV viremia with an equivalent risk of acute rejection and similar renal/pancreas function. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Pub.: 21 Apr '18, Pinned: 24 Apr '18