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

Keywords

  • Composite tissue allograft
  • Cytomegalovirus
  • Hand transplantation
  • Rejection

ASJC Scopus subject areas

  • Transplantation

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  • Cite this

    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, 80(4), 441-447. https://doi.org/10.1097/01.tp.0000168454.68139.0a