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Abstract: PO2096

Cytomegalovirus Infection in Renal Transplant Recipients: Incidence, Clinical Profile and Outcome

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Alaparthi, Phanisri, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
  • Guditi, Swarnalatha, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
  • Kinjarapu, Srinivasa Naidu, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
Background

Cytomegalovirus (CMV) is one of the commonly encountered opportunistic infection following renal transplantation, usually seen in the first 6 months of transplant. CMV diseases, untreated has a mortality rate of about 90% however has good response with prompt detection and antiviral therapy. With the changing immunosuppressive regimen, variation in pattern and occurrence of CMV infection can be seen. We studied the incidence, clinical profile and outcomes of CMV infection in renal transplant recipients at our center.

Methods

291 renal transplant recipients between 2014 and 2020 were reviewed, 27 patients who had CMV infection, diagnosed by CMV DNA detection with polymerase chain reaction were included in the study and their demographic details, clinical profile and outcome were noted and analyzed.

Results

Among the 291 renal allograft recipients, 27 patients had 34 episodes of CMV infection with an incidence of 9.27% with a mean follow up of 52.6 months. 37.1% received deceased donor renal transplant and 62.9% received live renal transplant. Mean age at transplant was 33.8yrs, 81.4% were males, 18.6% were females. rATG as induction was given in 11.1%, Basiliximab in 37.1% and 51.8% received no induction therapy, all of them received triple immunosuppression with steroid, tacrolimus and MMF as maintenance immunosuppression. PTDM was present in 33.4%. Valganciclovir prophylaxis post- transplant was given in 77.8% where as 22.2% did not receive prophylaxis. 20.5% infection episodes occurred in < 3months, 26.5% between 3-6 months, 11.8% between 6-12 months and 41.2% in >12months post-transplant. Symptomatic disease with fever, malaise and leucopenia was the most common presentation in 73.5% of patients and 26.4% had asymptomatic infection with leucopenia and transaminitis. All patients received iv Ganciclovir for 14-21days followed by oral valganciclovir for 90 days as treatment of infection episode. Patient survival and graft survival rate was 85.2% and 77.7% at our center.

Conclusion

Changing immunosuppressive regimen with early withdrawal of steroid and use of valganciclovir prophylaxis has been associated with lower incidence and milder form of CMV disease in our population. There seems to be a change in the traditional risk factors for CMV infection which needs to be further studied.