CMV MISMATCHED HAND-TRANSPLANTATION SHOULD BE AVOIDED

Abstract

P655 Aims: Since hand-transplantation was launched in 1998, a total of 24 hands/forearms have been transplanted worldwide. Cytomegalovirus (CMV) still represents one of the major problems in solid organ transplantation. We herein describe the management of CMV infection and/or disease in 5 CTA recipients. Methods: Immunosuppression consisted of Tacrolimus based triple drug therapy with ATG or CD25-receptor antagonist induction. Donor/recipient CMV match was negative/negative (n=1), negative/positive (n=1), positive/positive (n=2) and one patient underwent high risk CMV mismatched (positive/negative) transplantation. CMV testing following transplantation was performed using the pp65-antigenemia assay and the Murex Hybrid Capture CMV DNA assay. Patients were given Gancyclovir (GCV) i. v. followed by oral GCV or ValGCV prophylactically. Results: Patient and graft survival after a mean follow up of 29,4 months is 100 %. At least one rejection episode occurred in all cases with a CMV positive donor or recipient. In two of these patients excessive viral loads were observed. Gancyclovir treatment failed to permanently prevent CMV infection since every patient except for one CMV negative/negative matched developed CMV infection or disease. In those patients requiring a more toxic second line therapy (Foscarnet and/or Cidofovir) temporary renal impairment and neutropenia was observed. Conclusions: CMV infection/disease complicated the postoperative course after CTA transplantation in four of five recipients. High virus load and high level immunosuppression are thought to be responsible for this high complication rate. A close time correlation suggests an association between virus replication and rejection. Therefore, CMV mismatched CTA transplantation carries a high infectious as well as immunological risk and should be avoided.