S. Aguado

Cytomegalovirus Preemptive Therapy with Ganciclovir in Renal Transplant Patients Treated with OKT3

In an attempt to decrease the prevalence and severity of cytomegalovirus (CMV) disease, preemptive therapy with ganciclovir was administered to all renal transplant patients treated with OKT3 between February 1993 and December 1994 (26 patients). The results were compared with those of a historical group treated with OKT3 but not with ganciclovir (29 patients). Both groups were similar in age, sex, number of previous transplants, number of rejections, serological status of donor and recipient and OKT3 dose. Ganciclovir was administered during the period of treatment with OKT3. Only 2 (7.7%) treated patients developed CMV disease versus 11 (37.9%) of the control group (p = 0.01). In the control group the intensity of the disease was severe in 7 (63.6%) cases, whereas in the treated patients it was always of slight intensity (p = 0.01). In conclusion, preemptive therapy with ganciclovir during treatment with OKT3 decreases the prevalence and severity of CMV disease.

Herpes Simplex Virus Encephalitis in a Renal Transplant Patient: Diagnosis by Polymerase Chain Reaction Detection of HSV DNA

A case of herpes simplex virus (HSV) encephalitis with disseminated primary HSV infection in a renal transplant patient is described. The diagnosis of the disease was achieved by nested polymerase chain reaction (PCR)-DNA in cerebrospinal fluid (CSF). Other diagnostic measures (immunoglobulin [Ig] M and virological cultures both in blood and CSF) were negative. Blood IgG gave a false-positive signal. Although ganciclovir is not the drug of choice, its concomitant administration in our patient as a prophylactic measure against CMV infection may have decreased the usual severity normally expected in this kind of primary HSV infection. The subsequent increase in ganciclovir dose to full therapeutic range, which was implemented before the diagnosis was achieved, led to the disappearance of symptoms. The detection of PCR-DNA in CSF will probably become the diagnostic method of choice. One of its great advantages, in addition to its diagnostic reliability, is that it may obviate the performance of many cerebral biopsies.

Renal Transplantation in Fabry’s Disease

Dr. R. Peces, General Elorza 62, 5°B, Edificio Santa Ana, E-33001 Oviedo (Spain) Dear Sir, We have read with interest the report of Donati et al. [1] concerning a cooperative review of 12 patients with Fabry’s disease in replacement therapy for chronic renal failure. 8 patients underwent renal transplantation, 4 of whom had functioning kidneys for between 12 and 84 months. They concluded that Fabry’s disease should not be considered a relative contraindication to renal transplantation. We have recently reported in a local journal [2] a patient with Fabry’s disease who developed end-stage renal disease at 30 years of age. For 2 years he received hemodialysis treatment and suffered recurrent acropar-esthesias. The patient received a cadaver renal transplant with conventional immunosuppressive drugs which included steroids and azathioprine. The posttransplanta-tion course was without complications except for a late wound dehiscence. The patient was discharged with an excellently functioning graft and his acroparesthesias disappeared. Plasma pretransplantation α-galactosidase levels were 1.34 nmol/ml/h and 3 months after transplantation 1.85 nmol/ml/h (normal: 33.31–84.80 nmol/ml/h). His present status, 28 months after transplantation, is as follows: he works full time and can cover 40 km daily on his bicycle. Serum creatinine is 1.9 mg/dl, creatinine clearance is 78 ml/min and urine protein is negative. When terminal renal failure is caused by a multisystem disease, such as Fabry’s disease, treatment by regular hemodialysis or renal transplantation may be considered inadvisable, as death from failure of another organ is predictable. Experience to date, however, does not suggest that the extra problems arising when terminal renal failure is due to Fabry’s disease are sufficient to justify withholding therapy. Although plasma enzyme levels do not change following renal transplantation [3–5], the functioning kidney can provide clearance ofsubstrate by urinary excretion of an amount of ceramide [6,7] preventing their progressive accumulation in other tissues. The occurrence of the ceramide accumulation in the renal graft appears to add another risk to transplantation in this condition. Early histological recurrence of the disease in the engrafted kidney has been reported in 1 case [8]. In 2 other cases there was no evidence of gross accumulation of ceramide after 8 and 4 years and the deposits were scanty and localized only in

A Prospective Study on a Rapid Method for Diagnosing Cytomegalovirus Infections in Immunosuppressed Patients

A rapid assay is described for detection of cytomegalovirus in peripheral blood lymphocytes. It consists of an indirect immunofluorescence technique for detection of cytomegalovirus antigens by means of a monoclonal antibody directed against early viral coded proteins. This assay was compared with the conventional cell culture system. Patients transplanted between December 1986 and May 1988 were studied, and of 27 patients identified, two were excluded due to early graft failure. A total of 320 blood specimens obtained were studied, and from 12 patients cytomegalovirus was isolated in at least one specimen by conventional cell culture (in total 25 specimens). Results were available with the new technique within 6 h, whereas the cell culture took an average of 13 days to develop the typical cytopathic effects changes. Sensitivity and specificity compared with that of viral isolation in conventional cell culture was 92% and 95%, respectively. This technique provides an accurate and rapid diagnosis of cytomegalovirus infections, and allows specific antiviral therapy to be started earlier.