COMPLICATIONS - INFECTIONS

S. Abou antoun¹, J. Fields¹, M. Sandid¹, E. Wehbe¹, M. Assi^2
1, University of Kansas, wichita/KS/UNITED STATES OF AMERICA, ²Internal Medicine, University Of Kansas, wichita/UNITED STATES OF AMERICA

Body: Introduction Cytomegalovirus (CMV) disease is a major cause of morbidity after solid organ transplantation. The widespread use of antiviral prophylaxis has significantly decreased the incidence and severity of CMV disease. However, a subcategory of patients may develop recurrent or relapsing CMV disease, for which effective treatment becomes a challenge. CMV-hyperimmune globulin has been studied for CMV prophylaxis in solid organ transplantation and was associated with reduced CMV disease and CMV-associated death. Administration of CMV-hyperimmune globulin for treatment of CMV disease has not been studied yet. Methods We present a case series of four solid-organ transplant recipients (3 kidney and one heart) who developed late and recurrent CMV disease despite antiviral treatment. CMV-hyperimmune globulin was used at 150 mg/kg for the first dose, followed by 100 mg/kg for 7 more doses given every other day in an attempt to control their CMV disease. Results All patients were seronegative recipients with seropositive donors and received valganciclovir prophylaxis post transplantation for a duration that varied between 3 and 9 months. After discontinuation of prophylaxis all patients presented with CMV disease consisting of fever, viremia, and colitis and seroconverted at an interval varying between 2 and 12 months. Intravenous (IV) ganciclovir was administered at standard induction dose adjusted for kidney function and then was switched to oral valganciclovir after resolution of symptoms and at least one negative serum CMV polymerase chain reaction (PCR). One kidney transplant recipient developed ganciclovir resistance during treatment and was then treated with foscarnet. All patients had multiple recurrent episodes of CMV viremia with associated fever and systemic symptoms after every attempt to discontinue therapy. The four patients then received CMV-hyperimmune globulin and subsequently had efficient viral clearance as well as symptoms resolution. All are still in complete remission and off antiviral therapy after 24 months of follow up. Conclusion It is well known that cell-mediated immune response coincides with cessation of CMV-associated morbidity. However our report highlights the need for further studies concerning the contribution of humoral response to CMV infection and disease.

Disclosure: All authors have declared no conflicts of interest.