Böbrek nakli alıcılarında bir yıllık CMV enfeksiyonu deneyimi
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Date
2015-07-29
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Uludağ Üniversitesi
Abstract
Böbrek nakli son dönem böbrek yetmezliğinin en seçkin tedavisidir. Kullanılan immunsupresif tedavinin en önemli yan etkilerinden biri fırsatçı enfeksiyon riskinde artıştır. CMV, böbrek nakli alıcılarında en sık görülen viral enfeksiyon etkenidir. Çalışmamızda 2014 yılı içinde CMV enfeksiyonu tedavisi uygulanmış böbrek nakli alıcılarının özelliklerini araştırdık. Bu çalışmaya, 2014 yılı içerisinde merkezimizde PCR yöntemi ile CMV-DNA pozitifliği saptanmış ve hastaneye yatırılarak gansiklovir tedavisi uygulanmış 21 (yaş ortalaması 44.4±13.9 yıl, 8 kadın, 13 erkek,14 canlı, 7 kadaverik vericili) böbrek nakli alıcısı dahil edildi. Hastaların tıbbi bilgileri retrospektif olarak incelendi. Hastaların CMV-DNA kopya sayıları ortalama 26255,19±55501,75 kopya/mL’ydi ve ortalama nakil süreleri 34,1±53,7 aydı. CMV hastalığı oranı daha yüksekti (%66.7’ye karşılık %33.3). Halsizlik, ateş, öksürük-balgam, pnömoni, ishal, transaminaz yüksekliği görülen şikayet ve klinik bulgulardı. Ortalama gansiklovir kullanım süresi 20.24±6.2 gündü. Tedavi ile hastaların %76’sında CMV-DNA negatifleşti. Hastaların 5’i eks oldu, 5’inde graft kaybı gelişerek hemodiyaiz tedavisine geri döndü. Sonuçta, proflaksi ve preemptif (önceden) tedavi yaklaşımları ile CMV enfeksiyonu sıklığı azalsa da halen böbrek nakli alıcılarında önemli bir morbidite ve mortalite nedenidir. Proflaksi uygulanan alıcılarda geç dönemde CMV enfeksiyonu riski devam ettiğinden takiplerde dikkat edilmelidir.
Kidney transplantation is the most exclusive treatment of end stage kidney disease. Immunosuppressive treatment reveals opportunistic infections. Cytomegalovirus (CMV) is the most common viral pathogen isolated in kidney transplant recipients. In our study we investigated renal transplant recipients who received ganciclovir treatment for CMV infection in 2014. A total 21 kidney transplant recipients who received ganciclovir treatment for CMV-DNAemia by PCR in 2014. CMV infection was evaluated with CMV-DNA positivity measured by Abbott Real Time PCR technique. Retrospectively medical data were evaluated. Mean CMV-DNAemia was 26255,19±55501,75 copy/mL and mean transplantation duration was 34,1±53,7 months. CMV disease ratio was higher (66.7% vs 33.3%). The most common symptoms were weakness, fever, cough, pneumonitis, diarrhea, hepatitis. Mean duration of ganciclovir use was 20.24±6.2 days. In 76% recipient CMVDNA was negative at the end of the treatment. Five recipients died, 5 continued with hemodialysis because of graft lost. Although incidence of CMV infection decreased with prophylaxis and pre-emptive treatments, it is still an important cause of morbidity and mortality in kidney transplant recipients. Recipients who used prophylaxis have late onset CMV infection risk, they should be follow-up carefully.
Kidney transplantation is the most exclusive treatment of end stage kidney disease. Immunosuppressive treatment reveals opportunistic infections. Cytomegalovirus (CMV) is the most common viral pathogen isolated in kidney transplant recipients. In our study we investigated renal transplant recipients who received ganciclovir treatment for CMV infection in 2014. A total 21 kidney transplant recipients who received ganciclovir treatment for CMV-DNAemia by PCR in 2014. CMV infection was evaluated with CMV-DNA positivity measured by Abbott Real Time PCR technique. Retrospectively medical data were evaluated. Mean CMV-DNAemia was 26255,19±55501,75 copy/mL and mean transplantation duration was 34,1±53,7 months. CMV disease ratio was higher (66.7% vs 33.3%). The most common symptoms were weakness, fever, cough, pneumonitis, diarrhea, hepatitis. Mean duration of ganciclovir use was 20.24±6.2 days. In 76% recipient CMVDNA was negative at the end of the treatment. Five recipients died, 5 continued with hemodialysis because of graft lost. Although incidence of CMV infection decreased with prophylaxis and pre-emptive treatments, it is still an important cause of morbidity and mortality in kidney transplant recipients. Recipients who used prophylaxis have late onset CMV infection risk, they should be follow-up carefully.
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Keywords
CMV enfeksiyonu, Böbrek nakli, Kidney transplantation, Gansiklovir, Ganciclovir, CMV infection
Citation
Oruç, A. vd. (2015). ''Böbrek nakli alıcılarında bir yıllık CMV enfeksiyonu deneyimi''. Uludağ Üniversitesi Tıp Fakültesi Dergisi, 41(2), 79-82.