Viruses and Infections to ask about as a transplant recipient

[okarol]

Viruses and Infections to ask about as a transplant recipient:

PCP - Pneumocystis pneumonia - a form of pneumonia caused by the yeast-like fungus. The fungus appears to be present in healthy individuals also in the general population. In pneumocystis pneumonia, inflammation is caused by the growth of Pneumocystis carinii, a fungus-like organism that is widespread in the environment. PCP is ordinarily a rare disease, affecting only people with weakened immune systems. Many of these people are patients receiving drugs for organ transplants or cancer treatment.

BKV - BK Virus - The BK virus is a member of the polyomavirus family. Past infection with the BK virus is widespread, but significant consequences of infection are uncommon, with the exception of the immunocompromised. Renal transplant patients infected with this virus can be treated by using an antiviral drug. The BK virus rarely causes disease since many people who are infected with this virus are asymptomatic. If symptoms do appear then many of them will be mild such as having a respiratory infection or a fever. These are known as the primary infections. Latent infections can occur in the kidneys and sometimes in the brain. A latent infection occurs when the virus becomes reactivated. However it is not known how this virus is transmitted. It is known however that the virus is spread from person to person and not from an animal source. It has been suggested that this virus may be transmitted through respiratory fluids. Early diagnosis of BK nephropathy has been shown to positively impact organ survival.

CMV - Cytomegalovirus - Infection with CMV is a major cause of disease and death in immunocompromised patients, including organ transplant recipients, patients undergoing hemodialysis, patients with cancer, patients receiving immunosuppressive drugs, and HIV-infected patients. Because of this risk, exposing immunosuppressed patients to outside sources of CMV should be minimized. Whenever possible, patients without CMV infection should be given organs and/or blood products that are free of the virus. Patients without CMV infection who are given organ transplants from CMV-infected donors should be given prophylactic treatment with valganciclovir (ideally) or ganciclovir and require regular serological monitoring to detect a rising CMV titre, which should be treated early to prevent a potentially life-threatening infection becoming established.

VRE - Vancomycin-Resistant Enterococcus - End stage renal disease patients are at risk of Vancomycin-Resistant Enterococcus (VRE) infections. The first reports of VRE isolation were from hemodialysis patients. However, to date, VRE fecal colonization rates as well as associated risk factors in kidney transplant patients have not yet been established in prospective studies. Kidney transplant patients may be prone to developing high rates of VRE colonization and infection due to frequent use of antibiotics, particularly vancomycin both before and after transplantation. However, although kidney transplantation is the solid organ transplantation most frequently performed, little is known about prevalence and risk factors for fecal colonization by VRE among these patients.

[okarol]

 

[Chris]

I remember reading about this before my transplant, but notice one for sure is missing, EBV Epstein Barr Virus. (think I have the spelling correct)

[Golferchick]

My dad was VRE as well as had CMV. His body kept developing infections since he went into the hospital last September. He passed away last week (3/31/10).

They doctors could never determine what exactly what was wrong, every test / biopsy that he had (he had them all done) all came back negative. They do believe that his body came in contact with a virus and since he was immune suppressed that it attached the neurons in his brain.

[Chris]

Golferchick, that is similar to what I heard at a seminar I was at Saturday. The woman had all test done with urine and blood. All came back negative. She kept complaining and when the doctors did a colonoscopy, they found she had CMV. By that time, she said she was about to knock on death's door.

[RichardMEL]

About CMV. I think I read somewhere that a large percentage of the population have been exposed to the CMV virus, but obviously it is only a real concern for post-transplanted folks (or otherwise immunocompromised, like HIV+ patients etc). My question is - let's say I am, pre transplant, exposed to CMV - does this then mean bad karma for post transplant? Or is it only when you're exposed to it after transplant? Should I be asking my neph to test for CMV prior? (I presume they do this test at time of transplant, or possibly on a regular basis when you have transplant bloods taken - I am not certain on this and will ask locally about that).

Any ideas?

[Chris]

If you don't have any symptoms or are sick, no need to do the test. Your center will or should test you when you get the call or shortly after your transplant. Some centers will continuely test you every 1 to 2 months, others will not unless you are sick.

[Golferchick]

Unfortunately it was the VRE that did him in. He had lesions on his brain the brain biopsy, bone marrow, spinal, etc all came back negative. He did come up with CMV a few months after transplant and several times during the past 7 months he was treat prophetically for CMV but it never came back again.

[kellyt]

About CMV. I think I read somewhere that a large percentage of the population have been exposed to the CMV virus, but obviously it is only a real concern for post-transplanted folks (or otherwise immunocompromised, like HIV+ patients etc). My question is - let's say I am, pre transplant, exposed to CMV - does this then mean bad karma for post transplant? Or is it only when you're exposed to it after transplant? Should I be asking my neph to test for CMV prior? (I presume they do this test at time of transplant, or possibly on a regular basis when you have transplant bloods taken - I am not certain on this and will ask locally about that).

Any ideas?

Richard,
I just saw this thread for the first time tonight and thought it was approriate now that you have transplanted to answer.     To my knowledge, as a transplant patient it is best if you are CMV positive prior to transplant.  Then it doesn't matter what your donor is.  I was negative and my donor was positive, so I had to do 9 weeks of IVIG treatments directly after transplant.  I mean the same week I was discharged I started to go back for weekly treatments, multiple treatments every week.  It went by fast.

What did you find out about CMV after your transplant, Richard?  Were you positive or negative.  If negative, what treatment, if any, do you have to do?