A cytomegalovirus (CMV) donor positive/recipient negative liver transplant recipient developed CMV syndrome with presumed colitis 2 weeks after discontinuing the standard 3 months of valganciclovir prophylaxis. Treatment with intravenous ganciclovir (GCV) reduced, but did not clear, CMV replication. A CMV UL97 mutation (M460V) conferring GCV resistance was identified. Reduction of immunosuppression was followed by rapidly rising lymphocyte counts as well as by clearance of CMV viremia and of clinical symptoms. However, bilateral chorioretinitis was diagnosed 2 weeks later and treated with foscarnet and cidofovir. Then, right eye vitritis occurred necessitating vitrectomy due to a partially rhegmatogeneous retinal detachment. Because chorioretinitis-vitritis after rising lymphocyte counts and clearance of CMV viremia was strongly suggestive of an immune reconstitution syndrome (IRS)-like disease, we investigated CMV-specific T-cells in the peripheral blood available during follow-up. We found strong CD8(+) but only low CD4(+) T-cell responses (4.77% vs.<0.1%) to the CMV immediate early pp72, while responses to CMV-lysate or CMV-pp65 (CD4(+) <0.01%; CD8(+)<0.01%) were low. Over 16 weeks of follow-up, pp72-specific CD8(+) responses declined, while responses to pp65 gradually increased (CD4(+) 0.16%; CD8(+) 0.76%) indicating a slowly adapting CMV-specific cellular T-cell response. Review of 12,653 published liver transplant patients identified only 14 (0.1%) reported cases of CMV-associated chorioretinitis at a median 41.7 weeks post transplant. CMV-associated opthalmologic complications late post transplantation may possibly involve 2 different entities of cytopathic retinitis and IRS-like chorioretinitis-vitritis.

Cytomegalovirus-associated chorioretinitis after liver transplantation: case report and review of the literature

For most opportunistic mycoses no optimum duration of antifungal therapy has been defined. Although a long course of therapy is prudent, especially for mycelial fungal infections, excessively and unnecessarily extended courses of treatment incur a risk of toxicity and the expense of the therapeutic regimen. On the basis of existing reports on the pathogenesis and the effect of duration of therapy and other variables on outcome and response rate in fungal infections, this review proposes guidelines that may facilitate a rational approach to decision-making about the duration of antifungal therapy.

/pdf/treatment-of-opportunistic-mycoses-how-long-is-long-enough-5eeckz7zgk.pdf

Treatment of opportunistic mycoses: how long is long enough?

Detection of human leukocyte antigen compatibility and antibodies in liver transplantation in China.

Background/aims Few studies on Cytomegalovirus (CMV) infection in adult-to-adult living donor liver transplantation (LDLT) have been reported The aim of this study was to analyze the incidence, risk factors and management of CMV infection after LDLT Methodology Retrospective analysis was performed with 72 consecutive adult cases Results CMV antigenemia was demonstrated in 31 (431%) patients and 9 patients (125%) manifested fever Twelve patients were treated with intravenous ganciclovir (GCV) injection There was improvement in 10 patients; foscanet concomitant with CMV-IG was administered in one patient who had an adverse effect resulting in improvement and another one resulted in death from sepsis Twelve patients were given oral valganciclovir (VGCV) and all showed improvement ABO incompatible transplantation was associated with CMV infection after LDLT in both the univariate (p=0005) and multivariate analyses (p=004) After discharge 12 out of 63 patients (19%) suffered from CMV infection and all of them were taking steroid Conclusions ABO incompatible transplantation was demonstrated as a risk factor for CMV infection during hospitalization After discharge immunosuppressive status seemed to be more essential as a predictor for CMV infection Routine examination to detect CMV antigenemia is needed especially in patients with potentially over-immunosuppressive conditions in out-patient clinics

Management of cytomegalovirus infection after living donor liver transplantation.

Transplantation

Cytomegalovirus infection in liver transplant recipients.

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Cytomegalovirus infection in liver transplant recipients.