Abstract: SA-PO1002
A Complicated Case of Severe Cytomegalovirus (CMV) Retinitis after 2 Decades of Kidney Transplant
Session Information
- Transplantation: Clinical - 4
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Habib, Hafsa, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Sarosh, Muneeba, Advocate Aurora Health Inc, Milwaukee, Wisconsin, United States
- Chaudhry, Shahzad, Advocate Aurora Health Inc, Milwaukee, Wisconsin, United States
- Thomas, Beje S., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Batool, Aisha, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
Introduction
CMV stands as the primary pathogen following kidney transplantation especially within the initial 6 months post-transplantation, CMV manifests through primo-infection, reactivation of latent infection, or reinfection with a distinct strain. While CMV retinitis is infrequent among kidney transplant recipients compared to its prevalence in HIV-infected individuals.
Case Description
A 44-year-old female with a history of ESRD from type 1 diabetes, who underwent renal transplantation thrice with most recent DDKT in 2002. She was Transitioned from tacrolimus to belatacept 18 years after her DDKT, she has been on belatacept therapy for 40 months. She presented with progressive eye pain and declining vision. Outpatient eye examination revealed retinal infiltrate in the right eye surpassing the left eye, along with subacute posterior vitreous detachment in the right eye. She was admitted with initial CT Head, MRI Brain and CSF were negative for CMV. Serum CMV PCR NAAT revealed 157,000 copies. She started on IV and intravitreal Ganciclovir. She remains admitted inpatient with slight improvement of her visual symptoms. Visual acuity at 20/100 OD and 20/50 OS. OCT reveals no subretinal fluid, while Optos photography shows similar lesion size and distribution overall, with a potential slight increase in the size of an inferior lesion in the right eye. She is planned for IVIGG infusion and transitioning from belatacept to CNI.
Discussion
First-line treatment for CMV retinitis involves systemic and intravitreal ganciclovir, although prolonged therapy may lead to resistance due to mutations in viral genes. Kidney transplant recipients with CMV retinitis have shown multidrug resistance in some cases. The advent of belatacept underscores the importance of identifying potential new side effects of this treatment, particularly considering the cellular-mediated immune response against the virus by CMV-specific T-lymphocytes. The safety of belatacept concerning CMV infection remains inadequately studied.