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POSTTRANSPLANT SITOMEGALOVIRUS HASTALIĞI

POSTTRANSPLANT CYTOMEGALOVIRUS DISEASE

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 1998

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
in this study patients with cytomegalovirus(CMV) disease among 548 renal transplant patients beingfollowed up at our clinic during 1983-1998, were evaluated. Eight patients (%1.4) had active CMV disease. The average period of time between the transplantation and the infection was 5.3±3.2 months As an extra immunosupressive therapy two patients receivedATG, two ALG and one patient high dose methylprednisolone. Cytomegalovirus serology was positive two sided in two patients who had their transplantations in our unit. There were not sufficient data about other patients and their donors. Six of the patients had pneumonia, one patient had hepatitis and pnemonia and one of them had acute lower gastrointestinal system bleeding. Though immunosupressive therapy was tapered to minimum during the infections, no allograft dysfunction was observed. Two patients also had pnemonia due to Pneumocyctis carinii and other agents and three patients had apperent bone marrow supression. Six patients were diagnosed by CMV- Ag positivity in serum, 2 by CMV-Ag positivity in bronchoalveolar lavage and 2 by both CMV-Ag positsivity in serum and histopathology. Seven patients were treated with gancyclovir and nonspesific gammaglobulin and one with gammaglobulin only. The patient with lower gastrointestinal bleeding had an operation and received gancylovir therapy. While three patients died, all other patients survived. It is concluded that CMV disease presents differently in clinic and the mortality rate is high among renal transplant patients. It was noteworthy that though immunosupressive therapy was tapered off there was no allograft dysfunction.
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Abstract (Original Language): 
Bu çalışmada 1983 - 1998 yılları arasında poliklinik serimizdeki toplam 548 renal transplantasyon hastası içinden sitomegalovirus(CMV) infeksiyonu geçiren hastalar ve bunların özellikleri araştırıldı. Toplam 8 (% 1.4) olguda aktif CMV hastalığı saptandı. Transplantasyon ile infeksiyonun tanısı arasındaki süre ortalama 5.3 + 3.2 ay olarak bulundu. îmmunosupressif tedavi protokolü içinde 2 hastada ATG, 2 hastada ALG, bir hastada ise yüksek doz metil prednisolon tedavisi kullanılmıştı. Ünitemizde transplantasyon yapılan 2 hastada CMV serolojisi çift taraflı pozitifti. Diğer hastalar ve donörlerin ise preoperatuar dönemdeki CMVserolojileri ile ilgili sağlıklı veriler elde edilemedi. Klinikte 6 hastada pnömoni, 1 hastada hepatit ve pnömoni, bir hastada ise abondan alt gastrointestinal kanama görüldü. Îmmunosupressif tedavi minimale indirilmesine karşın aktif infeksiyon süresince belirgin bir allograft disfonksiyonu ile karşılaşılmadı. İki hastada CMV infeksiyonu ile birlikte Pneumocyctis carinii ve diğer etkenlere bağlı pnömoni, üç olguda ise belirgin kemik iliği depresyonu izlendi. Tanı 6 hastada kanda CMV-Ag saptanması ile, 2 hastada bronkoalveoler lavajda CMV-Ag saptanması ile, 2 hastada ise hem kanda CMV-Ag hem de histopatolojik inceleme ile konuldu. Tedavi olarak 7hastada gansiklovir ve nonspesifık gamaglobulin, 1 hastada ise yalnızca gamaglobulin tedavisi kullanıldı. Abondan alt gastrointestinal kanama ile seyreden bir hastada ise gansiklovir tedavisi ile birlikte cerrahi girişim uygulandı. Üç hasta kaybedilirken diğer hastalarda şifa gözlendi. Sonuç olarak, posttransplant CMV hastalığının değişik klinik tablolarla ortaya çıkabileceği ve mortalite oranının oldukça yüksek olduğu kanısına varıldı. İnfeksiyon seyri sırasında, immunosupressif tedavilerin azaltılmasına rağmen önemli allograft disfonksiyonu görülmemesi de dikkat çekiciydi.
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  • 1
35-39
  • Turkish

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