RESUMEN
We report two CMV naïve children who received deceased donor renal transplants from a CMV IgG-negative single donor. CMV IgG in both recipients and the donor were negative immediately prior to transplant. Both recipients had early recurrences of their original disease in their transplants, requiring multiple sessions of plasmapheresis. All blood products used were leukoreduced or CMV seronegative. A few days post-transplant, both recipients developed significant positive CMV viremia. Both required initiation of oral valganciclovir. Case 1 responded to oral valganciclovir only while the case 2 had a delayed response to it and hence required intravenous ganciclovir with good response. When checked retrospectively, CMV IgM in the donor was positive along with positive CMV DNA PCR from the white cells. Here we describe a very unusual scenario of CMV transmission in two pediatric renal transplant recipients from a single donor during the CMV window period.
Asunto(s)
Infecciones por Citomegalovirus/tratamiento farmacológico , Infecciones por Citomegalovirus/transmisión , Trasplante de Riñón/efectos adversos , Insuficiencia Renal/cirugía , Administración Oral , Adolescente , Anticuerpos Antivirales/sangre , Antivirales/uso terapéutico , Niño , Preescolar , Citomegalovirus , Femenino , Ganciclovir/administración & dosificación , Ganciclovir/análogos & derivados , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Masculino , Periodo Posoperatorio , Insuficiencia Renal/complicaciones , Insuficiencia Renal/virología , Estudios Retrospectivos , Factores de Riesgo , Receptores de Trasplantes , Resultado del Tratamiento , ValganciclovirRESUMEN
We report a 16-yr-old female who developed AN within a month after renal transplantation and its resolution after switching from tacrolimus to cyclosporine. Her initial maintenance immunosuppressive regimen after renal transplantation consisted of tacrolimus, mycophenolate, and steroid. She had 7 kg weight loss within the first month of transplant with subsequent 10, 12, 17, and 19 kg loss after three, five, seven, and nine months of transplant, respectively. Besides weight loss and disturbances in body image, the patient developed alopecia, bradycardia, and persistent secondary amenorrhea. Upon switching to cyclosporine from tacrolimus nine months after transplant, she started regaining weight with 5 kg gain within two months and 10 kg after four months. She restarted her menstrual cycle, alopecia and bradycardia resolved, and her body image disturbance improved. Here, we describe a very unusual neuropsychiatric side effect of tacrolimus and its resolution with another calcineurin inhibitor, cyclosporine, in an adolescent renal transplant recipient.