IMPACTS OF CYTOMEGALOVIRUS INFECTION IN RENAL TRANSPLANT RECIPIENTS

Abstract

Introduction: kidney transplantation is widely practiced around the world. Although generally yielding positive results, kidney transplants require prolonged use of immunosuppressive medications, which can cause adverse effects and increase the risk of infectious complications. One of the major complications is caused by cytomegalovirus (CMV). This condition can present as primary infection, when transmission occurs through the graft, or as reactivation, when the recipient is seropositive. Clinically, the infection can be asymptomatic or present as a disease, manifesting as a typical viral syndrome or, less commonly, as invasive disease. To detect the virus, a viremia test is necessary, which can be performed by antigen detection or PCR, with the latter being more sensitive. Risk factors include serological compatibility and the use of anti-lymphocyte antibodies. High-risk patients may receive preemptive treatment, which involves administering medications after virus detection but before symptoms appear, or prophylaxis, which is the preventive administration of medications to avoid infection. Recent studies indicate that ganciclovir resistance is an increasing concern. Alternatives include valganciclovir, foscarnet, or cidofovir. Advanced immune system monitoring techniques, such as the identification of specific T cell clones against CMV, may improve post-transplant management in high-risk patients. Objective: To present a clinical case of a young female patient with a history of simultaneous kidney-pancreas transplantation in October 2023, who developed invasive cytomegalovirus disease. To provide an analysis of the main clinical aspects of CMV infection during kidney transplantation, highlighting its predisposing factors and evaluating how this condition influences clinical progression, with a primary focus on intensive care approach and its perspectives. Methods: Information was collected through a review of medical records, patient interview, documentation of diagnostic methods the patient underwent, and a narrative literature review from various databases. Conclusion: It is essential for intensivists to consider the possibility of CMV infection in kidney transplant recipients who present with suggestive clinical signs. Strict measures are in place to reduce the risk of disease in high-risk patients after transplantation. Proper monitoring is crucial to minimize the risk of complications and morbidity and mortality. In some cases, empirical therapy may be necessary due to the potential severity of the condition.