Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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Late Cytomegalovirus Disease Causes Ileal Perforation after Kidney trasplantation

신 이식 후 소장 파열을 초래한 후기 cytomegalovirus 질환

  • Lee, Hee-Woo (Department of Pediatrics, Eulji University School of Medicine) ;
  • Hahn, Hye-Won (Department of Pediatrics, Eulji University School of Medicine) ;
  • Park, Young-Seo (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine)
  • 이희우 (을지대학교 의과대학 소아청소년과) ;
  • 한혜원 (을지대학교 의과대학 소아청소년과) ;
  • 박영서 (울산대학교 의과대학 서울아산병원 소아청소년과)
  • Received : 2010.10.26
  • Accepted : 2011.01.31
  • Published : 2011.04.30
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Abstract

Cytomegalovirus (CMV) is the single most common infection following kidney transplantation and despite prophylactic strategies and the development of new antiviral agents, it still remains a cause of considerable morbidity and mortality. Current literature suggests that CMV infection may trigger rejection. We report a case of late CMV disease in a preemptive seropositive recipient who did not receive CMV prophylaxis. Diarrhea and abdominal cramping persisted after the administration of mycophenolate mofetil (MMF) six months after transplantation and resulted in ileal perforation at eight months after transplantation. The boy recovered after six weeks of treatment with ganciclovir. MMF has been mooted as a risk factor for CMV infection since its introduction, and further investigations are required to confirm its role. More attention to infectious complications is necessary and serial monitoring of viral load is recommended when MMF is administered.

Cytomegalovirus (CMV)는 신 이식 후 발생하는 감염의 가장 흔한 원인으로, 예방요법과 새로운항 바이러스 제제의 도입에도 불구하고 심각한 결과를 초래하며, 거부반응을 촉진한다는 의견도 제시되고 있다. 저자들은 이식 전 CMV 양성이었던 환아에서 후기 CMV 질환이 발병한 증례를 보고하고자 한다. 이식 6개월 후 mycophenolate mofetil ((MMF)을 투여한 후로 설사와 복통을 호소하던 환아는 이식 후 8개월에 소장이 파열되었다. 환아는 6주간의 치료후에 호전되었다. CMV감염의 위험 인자로 MMF의 역할에 대해서는 더 논의가 필요하나, MMF 투여 시이식 후 바이러스 감염에 대한 주의와 주기적인 추적 관찰이 필요하다.

Keywords

References

  1. Pouteil-Noble C, Ecochard R, Landrivon G, Donia-Maged A, Tardy JC, Bosshard S, et al. Cytomegalovirus infection-an etiological factor for rejection? A prospective study in 242 renal transplant patients. Transplantation 1993;55:851-7. https://doi.org/10.1097/00007890-199304000-00032
  2. Bock GH, Sullivan EK, Miller D, Gimon D, Alexander S, Eloois E, et al. Cytomegalovirus infections following renal transplantation-effects of antiviral prophylaxis: A report of the North American Pediatric Renal Transplant Cooperative Study. Pediatric Nephrol 1997;11:665-71. https://doi.org/10.1007/s004670050361
  3. Robinson LG, Hilinski J, Graham F, Hymes L, Beck-Sague CM, Hsia J, et al. Predictors of cytomegalovirus disease among pediatric transplant recipients within one year of renal transplantation. Pediatr Transplant 2002;6: 111-8. https://doi.org/10.1034/j.1399-3046.2002.01049.x
  4. Wolf DG, Spector SA. Early diagnosis of human cytomegalovirus disease in transplant recipient by DNA amplification in plasma. Transplantation 1993;56:330-4. https://doi.org/10.1097/00007890-199308000-00014
  5. Fisher L, Rautenberg P, Bienengrabe H, Leimenstoll G. Antigenemia, immunoblotting, and enzyme immunoassay for early diagnosis of cytomegalovirus infection in renal transplant patients. Transpl Int 1993;6:201-5. https://doi.org/10.1111/j.1432-2277.1993.tb00647.x
  6. Komorowski RA, Cohen EB, Kauffman HM, Adams MB. Gastrointestinal complications in renal transplant recipients. Am J Clin Pathol 1986;86:161-7. https://doi.org/10.1093/ajcp/86.2.161
  7. Mathew TH. A blinded, long-term, randomized multicenter study of mycophenolate mofetil in cadavaric renal transplantation: results at three years. Tricontinental Mycophenolate Mofetil Renal Transplantation Study Group. Transplantation 1998;65:1450-4. https://doi.org/10.1097/00007890-199806150-00007
  8. Sarmiento JM, Dockrell DH, Schwab TR, Munn SR, Paya CV. Mycophenolate mofetil increases cytomegalovirus invasive organ disease in renal transplant patients. Clin Transplant 2000;14:136-8. https://doi.org/10.1034/j.1399-0012.2000.140206.x
  9. ter Meulen CG, Wetzels JFM, Hilbrands LB. The influence of mycophenolate mofetil on the incidence and severity of primary cytomegalovirus infections and disease after renal transplantation. Nephrol Dial Transplant 2000;15:711-4. https://doi.org/10.1093/ndt/15.5.711
  10. Abbott KC, Hypolite IO, Viola R, Poropatich RK, Hshieh P, Cruess D, et al. Hospitalization for cytomegalovirus disease after renal transplantation in the United States. Ann Epidemiol 2002;12:402-9. https://doi.org/10.1016/S1047-2797(01)00283-6
  11. Zylber-Katz E, Granot E. Abrupt increase of Tacrolimus blood levels during an episode of Shigella infection in a child after liver transplantation. Ther Drug Monit 2001;23: 647-9. https://doi.org/10.1097/00007691-200112000-00009
  12. Hochleitner BW, Bosmuller C, Nehoda H, Fruhwirt M, Simma B, Ellemunter H, et al. Increased tacrolimus levels during diarrhea. Transpl Int 2001;14:230-3. https://doi.org/10.1111/j.1432-2277.2001.tb00050.x
  13. Slifkin M, Tempesti P, Poutsiaka DD, Snydman DR. Late and atypical cytomegalovirus disease in solid-organ transplant recipients. Clin Infect Dis 2001;33:E62-8. https://doi.org/10.1086/322663
  14. Snydman DR, Werner BG, Heinze-Lacey B, Veradi VP, Tilner NL. Use of cytomegalovirus immune globulin to prevent cytomegalovirus disease in renal transplant recipients. N Engl J Med 1987;317:1049-54. https://doi.org/10.1056/NEJM198710223171703
  15. Tanaka Y, Kanda Y, Kami M, Mori S, Amaki T, Kusumi E, et al. Monitoring cytomegalovirus infection by antigenemia assay and two distinct plasma real-time PCR methods after hematopoietic stem cell transplantation. Bone Marrow Transplant 2002;30:315-9. https://doi.org/10.1038/sj.bmt.1703661
  16. Griscelli F, Barrois M, Chauvin S, Lastere S, Bellet D, Bourhis JH. Quantitation of human cytomegalovirus DNA in bone marrow transplant recipient by real-time PCR. J Clin Microbiol 2001;39:4362-9. https://doi.org/10.1128/JCM.39.12.4362-4369.2001
  17. Jassal SV, Roscoe JM, Zaltzman JS, Mazzulli T, Krajden M, Gadawski M. Clinical practice guidelines: prevention of cytomegalovirus disease after renal transplantation. J Am Soc Nephrol 1998;9:1697-708.