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Cytomegalovirus (CMV) infection is the most frequent viral infectious complication after TR. It has direct and indirect consequences, with an impact on morbidity and mortality.
The aim of this study is to describe the epidemiological and clinico-biological characteristics, as well as the therapeutic management and evolution of kidney transplant recipients who developed CMV infection in the nephrology, dialysis and renal transplantation department of the Sahloul University Hospital in Sousse.
This is an observational, retrospective study including renal transplant patients followed at the Nephrology Department of CHU Sahloul in whom a CMV infection was confirmed by antigenemia or by PCR.
The number of TR patients during the study period was 315, of whom 56 (18%) presented with CMV infection. The mean age of the patients was 32 years, with a M/F sex ratio of 1.66. Recipients were immune to CMV in 47 cases.
All patients received induction treatment with either monoclonal antibodies (16%) or polyclonal antibodies (84%) and maintenance immunosuppression combining an antimetabolite and an anticalcineurin in addition to corticosteroid therapy. The mean time to onset of infection was 4.2 months.
The clinical picture of the disease was dominated by fever and digestive disorders, which occurred in 27 and 23 cases respectively.
Biologically, 42 patients had anaemia and cytolysis was noted in 8 patients. Ten patients had worsening graft function.
Therapeutic management was based on Gancyclovir IV in 43 patients and Valgancyclovir in 6 patients. The average duration of treatment with IV Gancyclovir was 15 days. Progression was favourable in 44 cases. One patient required a change in immunosuppressive treatment and 10 patients relapsed after 6 months.
CMV infection is the most common viral infection following kidney transplantation.
Early diagnosis and antiviral treatment have reduced mortality in invasive forms. An effective prophylactic strategy remains the best option.