Treatment of recurrent cytomegalovirus disease in patients receiving solid organ transplants
M. D. Sawyer, J. L. Mayoral, K. J. Gillingham, M. A. Kramer and D. L. Dunn
Department of Surgery, University of Minnesota, Minneapolis.
Tissue-invasive cytomegalovirus (TI-CMV) disease occurs commonly after
solid organ transplantation and has been associated with increased
allograft loss and patient mortality. Although ganciclovir has been
demonstrated to be an effective form of treatment for TI-CMV disease,
therapy may be followed by recurrence. The purpose of this study was to
determine the impact of recurrent TI-CMV disease on patient and allograft
survival. We studied 619 patients who underwent solid organ transplantation
(535 kidney transplants [253 from living related donors and 282 from
cadavers] and 84 combined cadaveric kidney-pancreas transplants) during a 3
1/2-year period. One hundred fourteen patients (18.4%) developed TI-CMV
disease and were treated with a standardized regimen of intravenous
ganciclovir for 14 to 21 days. Of the 114 patients in whom primary TI-CMV
disease developed, 28 (24.6%) developed recurrent TI-CMV disease more than
30 days after the initial episode, and these patients were retreated with
ganciclovir. Cure rates at 30 days were 98.9% in patients with primary
TI-CMV disease and 100% in patients with recurrent TI-CMV disease. Patients
who underwent cadaveric kidney or kidney-pancreas transplantation were more
likely to develop recurrent TI-CMV disease than were recipients of kidney
transplants from living related donors; antirejection therapy also was
associated with a higher incidence of recurrent TI-CMV disease. Patients
who developed TI-CMV disease exhibited lower rates of graft and patient
survival at 3 years than patients without TI-CMV disease or with solely
asymptomatic CMV infection, although recurrent TI-CMV disease did not
appear to exacerbate morbidity or mortality. We conclude that recurrent
episodes of TI-CMV disease do not appear to further adversely affect
patient or graft survival in comparison with primary TI-CMV disease in
ganciclovir-treated patients.
