Elsevier

Transplantation Proceedings

Volume 42, Issue 1, January–February 2010, Pages 74-78
Transplantation Proceedings

Complication
Early and Late Virological Monitoring of Cytomegalovirus, Epstein-Barr Virus, and Human Herpes Virus 6 Infections in Small Bowel/Multivisceral Transplant Recipients

https://doi.org/10.1016/j.transproceed.2009.12.032Get rights and content

Abstract

Background

Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) are the major causes of graft failure and posttransplantation mortality among small bowel and multivisceral transplantations (SB/MVT). Little is known about human herpes virus 6 (HHV-6) infections in transplant recipients.

Study Purpose

The purposes of this study were to analyze the clinical relevance of CMV, EBV, and HHV-6 infections after small bowel transplantation and to establish whether routine monitoring for HHV-6 infection should be recommended for the prevention of severe complications in this population.

Methods

Ten adult patients were monitored based on CMV, EBV, and HHV6 DNA quantifications in blood and biopsy tissue samples. Three patients were monitored for at least 5 months (early period) and 7 patients were monitored for 1 to 5 years after transplantation (late period).

Results

In the early period, despite prophylaxis all 3 patients developed symptomatic CMV infections: 1 fever/diarrhea, 1 enteritis and rejection, as well as 1 fever and pneumonia. Only 1 patient developed EBV and HHV-6 infections. The average time of onset of CMV infection was 3 months after transplantation and only 24 days for HHV6 infection. In the late period, of the 7 SB/MVT recipients only 1 developed an EBV infection at 2 years after transplantation. No CMV or HHV-6 infections were identified in any patient.

Conclusions

CMV infection is a major cause of organ disease and rejection in the early period after transplantation. EBV infection in adult recipients must be considered also in the late period, particularly in association with severe immunosuppression. Because HHV-6 infection occurs earlier than CMV/EBV, it may serve as an indicator for more intense virological surveillance.

Section snippets

Selection and Description of Participants

We enrolled 10 adult patients undergoing small bowel/multivisceral transplantation. There were 8 isolated small bowel and 2 multivisceral without liver transplants. The population comprised 7 men and 3 women aged between 22 and 51 years (average, 34).

Transplant recipients were categorized as early or late patients depending on the duration of the follow-up interval. Three of 10 patients were followed-up for 5 months posttransplantation from May to October 2008 (early period) and 7 patients were

Early Group (5 Months Posttransplantation Follow-Up)

All 3 patients studied during the first 5 months posttransplantation developed CMV symptomatic infections and were treated with gancyclovir. Their clinical and laboratory findings are summarized in Table 1.

Patient 1 developed a CMV infection (fever) at 112 days after a multivisceral transplantation without the liver. A high viral load was detected in the blood ranging from 11,400 to 152,300 copies/mL. No CMV positivity was detected in biopsy samples. In the same period a low EBV load was

Discussion

Intestinal transplant recipients require high levels of immunosuppression as a result of the large amount of lymphoid tissue in the graft, placing these patients at high risk for developing infections. The present study confirmed that despite prophylaxis CMV remains a major cause of organ disease, rejection, and recipient mortality in the first 6–8 months after transplantation. CMV infections occurred in all of the early group patients (3/3) with a mortality rate of 100% (3/3) due to sepsis in

Acknowledgments

We are grateful to Salustia Pop, Lorena Mezzofanti, Cristiana Grandi, and Antonella Maria Paglia for their excellent technical help. Anne Collins edited the English text.

References (13)

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Supported by grants from the Programma di Ricerca Regione Università Emilia Romagna 2007-2009 Area 1a (project coordinator G. Torelli), and the Italia-USA project 28C5/3.

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