Cytomegalovirus-related complications in human hand transplantation

Stefan Schneeberger, Stefano Lucchina, Marco Lanzetta, Gerald Brandacher, Claudia Bösmüller, Wolfgang Steurer, Fausto Baldanti, Clara Dezza, Raimund Margreiter, Hugo Bonatti

Research output: Contribution to journalArticle

Abstract

Background. Up to date, 24 hands/thumbs have been transplanted in 18 patients. We herein report on cytomegalovirus (CMV) infection, disease, and the adopted treatment. Methods. Immunosuppression consisted of tacrolimus-based triple-drug therapy with antithymocyte globuline or CD25-receptor antagonist induction. Donor/recipient CMV match was negative/negative (n=8), negative/positive (n=3), positive/positive (n=3), positive/negative (n=3) and unknown in one case. Six patients (three +/-, two +/+, and one -/+) received gancyclovir i.v. followed by oral gancyclovir or valgancyclovir for prophylaxis. Results. Patient and graft survival at a mean follow-up of 42.9 months were 100% and 91%, respectively. Of all patients tested for CMV, 45.5% developed CMV infection or disease. Two patients that were given a CMV-positive graft showed very high viral loads (550 and 1200/200000 leukocytes) after transplantation. Gancyclovir treatment failed to permanently control CMV in 80% of the patients experiencing CMV infection. Those patients requiring more toxic second-line therapies (foscarnet/cidofovir) suffered from side effects such as nephrotoxicity, nausea, vomiting, and diarrhea. Conclusions. CMV infection/disease complicated the postoperative course after composite tissue allograft (CTA) transplantation in five of nine recipients challenged with the virus. The close time correlation suggests an association between virus replication and rejection in some cases. CMV represents the major infectious threat in CTA transplantation. Therefore, CMV-mismatch should be avoided and prophylaxis with valgancyclovir and anti-CMV hyperimmunoslobulin should be mandatory.

Original languageEnglish (US)
Pages (from-to)441-447
Number of pages7
JournalTransplantation
Volume80
Issue number4
DOIs
StatePublished - Aug 27 2005
Externally publishedYes

Fingerprint

Hand Transplantation
Cytomegalovirus
Cytomegalovirus Infections
Ganciclovir
Composite Tissue Allografts
Tissue Transplantation
Foscarnet
Poisons
Thumb
Tacrolimus
Graft Survival
Virus Replication
Viral Load
Immunosuppression
Nausea
Vomiting
Diarrhea
Leukocytes
Therapeutics
Hand

Keywords

  • Composite tissue allograft
  • Cytomegalovirus
  • Hand transplantation
  • Rejection

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Schneeberger, S., Lucchina, S., Lanzetta, M., Brandacher, G., Bösmüller, C., Steurer, W., ... Bonatti, H. (2005). Cytomegalovirus-related complications in human hand transplantation. Transplantation, 80(4), 441-447. https://doi.org/10.1097/01.tp.0000168454.68139.0a

Cytomegalovirus-related complications in human hand transplantation. / Schneeberger, Stefan; Lucchina, Stefano; Lanzetta, Marco; Brandacher, Gerald; Bösmüller, Claudia; Steurer, Wolfgang; Baldanti, Fausto; Dezza, Clara; Margreiter, Raimund; Bonatti, Hugo.

In: Transplantation, Vol. 80, No. 4, 27.08.2005, p. 441-447.

Research output: Contribution to journalArticle

Schneeberger, S, Lucchina, S, Lanzetta, M, Brandacher, G, Bösmüller, C, Steurer, W, Baldanti, F, Dezza, C, Margreiter, R & Bonatti, H 2005, 'Cytomegalovirus-related complications in human hand transplantation', Transplantation, vol. 80, no. 4, pp. 441-447. https://doi.org/10.1097/01.tp.0000168454.68139.0a
Schneeberger S, Lucchina S, Lanzetta M, Brandacher G, Bösmüller C, Steurer W et al. Cytomegalovirus-related complications in human hand transplantation. Transplantation. 2005 Aug 27;80(4):441-447. https://doi.org/10.1097/01.tp.0000168454.68139.0a
Schneeberger, Stefan ; Lucchina, Stefano ; Lanzetta, Marco ; Brandacher, Gerald ; Bösmüller, Claudia ; Steurer, Wolfgang ; Baldanti, Fausto ; Dezza, Clara ; Margreiter, Raimund ; Bonatti, Hugo. / Cytomegalovirus-related complications in human hand transplantation. In: Transplantation. 2005 ; Vol. 80, No. 4. pp. 441-447.
@article{f730906ebfcc476aab744ecf3b820303,
title = "Cytomegalovirus-related complications in human hand transplantation",
abstract = "Background. Up to date, 24 hands/thumbs have been transplanted in 18 patients. We herein report on cytomegalovirus (CMV) infection, disease, and the adopted treatment. Methods. Immunosuppression consisted of tacrolimus-based triple-drug therapy with antithymocyte globuline or CD25-receptor antagonist induction. Donor/recipient CMV match was negative/negative (n=8), negative/positive (n=3), positive/positive (n=3), positive/negative (n=3) and unknown in one case. Six patients (three +/-, two +/+, and one -/+) received gancyclovir i.v. followed by oral gancyclovir or valgancyclovir for prophylaxis. Results. Patient and graft survival at a mean follow-up of 42.9 months were 100{\%} and 91{\%}, respectively. Of all patients tested for CMV, 45.5{\%} developed CMV infection or disease. Two patients that were given a CMV-positive graft showed very high viral loads (550 and 1200/200000 leukocytes) after transplantation. Gancyclovir treatment failed to permanently control CMV in 80{\%} of the patients experiencing CMV infection. Those patients requiring more toxic second-line therapies (foscarnet/cidofovir) suffered from side effects such as nephrotoxicity, nausea, vomiting, and diarrhea. Conclusions. CMV infection/disease complicated the postoperative course after composite tissue allograft (CTA) transplantation in five of nine recipients challenged with the virus. The close time correlation suggests an association between virus replication and rejection in some cases. CMV represents the major infectious threat in CTA transplantation. Therefore, CMV-mismatch should be avoided and prophylaxis with valgancyclovir and anti-CMV hyperimmunoslobulin should be mandatory.",
keywords = "Composite tissue allograft, Cytomegalovirus, Hand transplantation, Rejection",
author = "Stefan Schneeberger and Stefano Lucchina and Marco Lanzetta and Gerald Brandacher and Claudia B{\"o}sm{\"u}ller and Wolfgang Steurer and Fausto Baldanti and Clara Dezza and Raimund Margreiter and Hugo Bonatti",
year = "2005",
month = "8",
day = "27",
doi = "10.1097/01.tp.0000168454.68139.0a",
language = "English (US)",
volume = "80",
pages = "441--447",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Cytomegalovirus-related complications in human hand transplantation

AU - Schneeberger, Stefan

AU - Lucchina, Stefano

AU - Lanzetta, Marco

AU - Brandacher, Gerald

AU - Bösmüller, Claudia

AU - Steurer, Wolfgang

AU - Baldanti, Fausto

AU - Dezza, Clara

AU - Margreiter, Raimund

AU - Bonatti, Hugo

PY - 2005/8/27

Y1 - 2005/8/27

N2 - Background. Up to date, 24 hands/thumbs have been transplanted in 18 patients. We herein report on cytomegalovirus (CMV) infection, disease, and the adopted treatment. Methods. Immunosuppression consisted of tacrolimus-based triple-drug therapy with antithymocyte globuline or CD25-receptor antagonist induction. Donor/recipient CMV match was negative/negative (n=8), negative/positive (n=3), positive/positive (n=3), positive/negative (n=3) and unknown in one case. Six patients (three +/-, two +/+, and one -/+) received gancyclovir i.v. followed by oral gancyclovir or valgancyclovir for prophylaxis. Results. Patient and graft survival at a mean follow-up of 42.9 months were 100% and 91%, respectively. Of all patients tested for CMV, 45.5% developed CMV infection or disease. Two patients that were given a CMV-positive graft showed very high viral loads (550 and 1200/200000 leukocytes) after transplantation. Gancyclovir treatment failed to permanently control CMV in 80% of the patients experiencing CMV infection. Those patients requiring more toxic second-line therapies (foscarnet/cidofovir) suffered from side effects such as nephrotoxicity, nausea, vomiting, and diarrhea. Conclusions. CMV infection/disease complicated the postoperative course after composite tissue allograft (CTA) transplantation in five of nine recipients challenged with the virus. The close time correlation suggests an association between virus replication and rejection in some cases. CMV represents the major infectious threat in CTA transplantation. Therefore, CMV-mismatch should be avoided and prophylaxis with valgancyclovir and anti-CMV hyperimmunoslobulin should be mandatory.

AB - Background. Up to date, 24 hands/thumbs have been transplanted in 18 patients. We herein report on cytomegalovirus (CMV) infection, disease, and the adopted treatment. Methods. Immunosuppression consisted of tacrolimus-based triple-drug therapy with antithymocyte globuline or CD25-receptor antagonist induction. Donor/recipient CMV match was negative/negative (n=8), negative/positive (n=3), positive/positive (n=3), positive/negative (n=3) and unknown in one case. Six patients (three +/-, two +/+, and one -/+) received gancyclovir i.v. followed by oral gancyclovir or valgancyclovir for prophylaxis. Results. Patient and graft survival at a mean follow-up of 42.9 months were 100% and 91%, respectively. Of all patients tested for CMV, 45.5% developed CMV infection or disease. Two patients that were given a CMV-positive graft showed very high viral loads (550 and 1200/200000 leukocytes) after transplantation. Gancyclovir treatment failed to permanently control CMV in 80% of the patients experiencing CMV infection. Those patients requiring more toxic second-line therapies (foscarnet/cidofovir) suffered from side effects such as nephrotoxicity, nausea, vomiting, and diarrhea. Conclusions. CMV infection/disease complicated the postoperative course after composite tissue allograft (CTA) transplantation in five of nine recipients challenged with the virus. The close time correlation suggests an association between virus replication and rejection in some cases. CMV represents the major infectious threat in CTA transplantation. Therefore, CMV-mismatch should be avoided and prophylaxis with valgancyclovir and anti-CMV hyperimmunoslobulin should be mandatory.

KW - Composite tissue allograft

KW - Cytomegalovirus

KW - Hand transplantation

KW - Rejection

UR - http://www.scopus.com/inward/record.url?scp=23944448047&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=23944448047&partnerID=8YFLogxK

U2 - 10.1097/01.tp.0000168454.68139.0a

DO - 10.1097/01.tp.0000168454.68139.0a

M3 - Article

C2 - 16123716

AN - SCOPUS:23944448047

VL - 80

SP - 441

EP - 447

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 4

ER -