Renal allograft re-use and herpetic re-infection

Stella Setyapranata, Stephen Geoffrey Holt, Kate J Wiggins, William Mulley, Peter G Kerr, Anthony J Landgren, Damon Peter Eisen, Andrew Young, Helen Opdam, Amanda Robertson, Khashayar Asadi, Peter D Hughes

Research output: Contribution to journalArticleOther

5 Citations (Scopus)

Abstract

A middle-aged man received a kidney transplant from a deceased multi-organ donor. The recipient suffered cardiac arrest several days post-operatively and sustained hypoxic brain injury and was declared brain dead. Following the family s consent, the allograft kidney was retrieved and re-transplanted into a man with end-stage renal failure secondary to reflux nephropathy. The liver was not transplanted due to suspicion of fatty changes based on macroscopic appearance. After transplantation of other organs, liver histology revealed coagulative parenchymal necrosis with nuclear inclusions and moderate parenchymal cholestasis, suggestive of herpes viral hepatitis. Renal implantation biopsy showed histiocytes with enlarged nuclei containing viral inclusions in the capsular fibrous tissue, with positive immunostaining for herpes simplex virus (HSV). Anti-viral therapy was commenced immediately after obtaining histological evidence of donor HSV infection. Our recipient had pre-formed immunoglobulin G antibodies to HSV-1 and HSV-2, and was immunoglobulin M negative pre-transplant. HSV viraemia was detected day 5 post-transplant with a viral load of 7688 copies/mL by polymerase chain reaction assay. The recipient completed a 30 day course of intravenous ganciclovir before switching to oral valganciclovir as standard cytomegalovirus prophylaxis. The HSV polymerase chain reaction became undetectable on day 7 of intravenous ganciclovir and has remained undetectable. The patient remains well 9 months post-transplant with an estimated glomerular filtration rate of 61 mL/min per 1.73 m(2). Although renal allograft re-use has been shown to be technically possible with a good outcome in this recipient, this does raise issues including assessment of allografts that have undergone repeated severe ischaemic insults and the potential of transmission of infections.
Original languageEnglish
Pages (from-to)17 - 21
Number of pages5
JournalNephrology
Volume20 supp 1
DOIs
Publication statusPublished - 2015

Cite this

Setyapranata, S., Holt, S. G., Wiggins, K. J., Mulley, W., Kerr, P. G., Landgren, A. J., ... Hughes, P. D. (2015). Renal allograft re-use and herpetic re-infection. Nephrology, 20 supp 1, 17 - 21. https://doi.org/10.1111/nep.12423
Setyapranata, Stella ; Holt, Stephen Geoffrey ; Wiggins, Kate J ; Mulley, William ; Kerr, Peter G ; Landgren, Anthony J ; Eisen, Damon Peter ; Young, Andrew ; Opdam, Helen ; Robertson, Amanda ; Asadi, Khashayar ; Hughes, Peter D. / Renal allograft re-use and herpetic re-infection. In: Nephrology. 2015 ; Vol. 20 supp 1. pp. 17 - 21.
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abstract = "A middle-aged man received a kidney transplant from a deceased multi-organ donor. The recipient suffered cardiac arrest several days post-operatively and sustained hypoxic brain injury and was declared brain dead. Following the family s consent, the allograft kidney was retrieved and re-transplanted into a man with end-stage renal failure secondary to reflux nephropathy. The liver was not transplanted due to suspicion of fatty changes based on macroscopic appearance. After transplantation of other organs, liver histology revealed coagulative parenchymal necrosis with nuclear inclusions and moderate parenchymal cholestasis, suggestive of herpes viral hepatitis. Renal implantation biopsy showed histiocytes with enlarged nuclei containing viral inclusions in the capsular fibrous tissue, with positive immunostaining for herpes simplex virus (HSV). Anti-viral therapy was commenced immediately after obtaining histological evidence of donor HSV infection. Our recipient had pre-formed immunoglobulin G antibodies to HSV-1 and HSV-2, and was immunoglobulin M negative pre-transplant. HSV viraemia was detected day 5 post-transplant with a viral load of 7688 copies/mL by polymerase chain reaction assay. The recipient completed a 30 day course of intravenous ganciclovir before switching to oral valganciclovir as standard cytomegalovirus prophylaxis. The HSV polymerase chain reaction became undetectable on day 7 of intravenous ganciclovir and has remained undetectable. The patient remains well 9 months post-transplant with an estimated glomerular filtration rate of 61 mL/min per 1.73 m(2). Although renal allograft re-use has been shown to be technically possible with a good outcome in this recipient, this does raise issues including assessment of allografts that have undergone repeated severe ischaemic insults and the potential of transmission of infections.",
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Setyapranata, S, Holt, SG, Wiggins, KJ, Mulley, W, Kerr, PG, Landgren, AJ, Eisen, DP, Young, A, Opdam, H, Robertson, A, Asadi, K & Hughes, PD 2015, 'Renal allograft re-use and herpetic re-infection', Nephrology, vol. 20 supp 1, pp. 17 - 21. https://doi.org/10.1111/nep.12423

Renal allograft re-use and herpetic re-infection. / Setyapranata, Stella; Holt, Stephen Geoffrey; Wiggins, Kate J; Mulley, William; Kerr, Peter G; Landgren, Anthony J; Eisen, Damon Peter; Young, Andrew; Opdam, Helen; Robertson, Amanda; Asadi, Khashayar; Hughes, Peter D.

In: Nephrology, Vol. 20 supp 1, 2015, p. 17 - 21.

Research output: Contribution to journalArticleOther

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T1 - Renal allograft re-use and herpetic re-infection

AU - Setyapranata, Stella

AU - Holt, Stephen Geoffrey

AU - Wiggins, Kate J

AU - Mulley, William

AU - Kerr, Peter G

AU - Landgren, Anthony J

AU - Eisen, Damon Peter

AU - Young, Andrew

AU - Opdam, Helen

AU - Robertson, Amanda

AU - Asadi, Khashayar

AU - Hughes, Peter D

PY - 2015

Y1 - 2015

N2 - A middle-aged man received a kidney transplant from a deceased multi-organ donor. The recipient suffered cardiac arrest several days post-operatively and sustained hypoxic brain injury and was declared brain dead. Following the family s consent, the allograft kidney was retrieved and re-transplanted into a man with end-stage renal failure secondary to reflux nephropathy. The liver was not transplanted due to suspicion of fatty changes based on macroscopic appearance. After transplantation of other organs, liver histology revealed coagulative parenchymal necrosis with nuclear inclusions and moderate parenchymal cholestasis, suggestive of herpes viral hepatitis. Renal implantation biopsy showed histiocytes with enlarged nuclei containing viral inclusions in the capsular fibrous tissue, with positive immunostaining for herpes simplex virus (HSV). Anti-viral therapy was commenced immediately after obtaining histological evidence of donor HSV infection. Our recipient had pre-formed immunoglobulin G antibodies to HSV-1 and HSV-2, and was immunoglobulin M negative pre-transplant. HSV viraemia was detected day 5 post-transplant with a viral load of 7688 copies/mL by polymerase chain reaction assay. The recipient completed a 30 day course of intravenous ganciclovir before switching to oral valganciclovir as standard cytomegalovirus prophylaxis. The HSV polymerase chain reaction became undetectable on day 7 of intravenous ganciclovir and has remained undetectable. The patient remains well 9 months post-transplant with an estimated glomerular filtration rate of 61 mL/min per 1.73 m(2). Although renal allograft re-use has been shown to be technically possible with a good outcome in this recipient, this does raise issues including assessment of allografts that have undergone repeated severe ischaemic insults and the potential of transmission of infections.

AB - A middle-aged man received a kidney transplant from a deceased multi-organ donor. The recipient suffered cardiac arrest several days post-operatively and sustained hypoxic brain injury and was declared brain dead. Following the family s consent, the allograft kidney was retrieved and re-transplanted into a man with end-stage renal failure secondary to reflux nephropathy. The liver was not transplanted due to suspicion of fatty changes based on macroscopic appearance. After transplantation of other organs, liver histology revealed coagulative parenchymal necrosis with nuclear inclusions and moderate parenchymal cholestasis, suggestive of herpes viral hepatitis. Renal implantation biopsy showed histiocytes with enlarged nuclei containing viral inclusions in the capsular fibrous tissue, with positive immunostaining for herpes simplex virus (HSV). Anti-viral therapy was commenced immediately after obtaining histological evidence of donor HSV infection. Our recipient had pre-formed immunoglobulin G antibodies to HSV-1 and HSV-2, and was immunoglobulin M negative pre-transplant. HSV viraemia was detected day 5 post-transplant with a viral load of 7688 copies/mL by polymerase chain reaction assay. The recipient completed a 30 day course of intravenous ganciclovir before switching to oral valganciclovir as standard cytomegalovirus prophylaxis. The HSV polymerase chain reaction became undetectable on day 7 of intravenous ganciclovir and has remained undetectable. The patient remains well 9 months post-transplant with an estimated glomerular filtration rate of 61 mL/min per 1.73 m(2). Although renal allograft re-use has been shown to be technically possible with a good outcome in this recipient, this does raise issues including assessment of allografts that have undergone repeated severe ischaemic insults and the potential of transmission of infections.

UR - http://www.ncbi.nlm.nih.gov/pubmed/25807853

U2 - 10.1111/nep.12423

DO - 10.1111/nep.12423

M3 - Article

VL - 20 supp 1

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JF - Nephrology

SN - 1320-5358

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Setyapranata S, Holt SG, Wiggins KJ, Mulley W, Kerr PG, Landgren AJ et al. Renal allograft re-use and herpetic re-infection. Nephrology. 2015;20 supp 1:17 - 21. https://doi.org/10.1111/nep.12423