CMV Retinitis in Transplant Patients

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Researchers report that the condition can lead to worsening visual acuity despite antiviral treatment.

 

Cytomegalovirus (CMV) retinitis is rare in organ transplant recipients, but it is progressive and is associated with high morbidity, according to researchers at the Mayo Clinic in Rochester, Minn.

 

They identified nine patients who were diagnosed with CMV retinitis in 14 eyes over a 15-year period. The group included five kidney, two liver, and one heart transplant recipient. The patients had a mean age of 58 years. The mean time to CMV retinitis diagnosis was nine months (range 4 months to 13 years) after transplantation, the investigators reported in Transplant Infectious Disease (2008;10:13-18).

 

Four patients had concomitant pneumonitis or hepatitis. Five (55%) had bilateral retinitis. Retinal involvement was 10% or less in eight eyes, greater than 10%, but no more than 50% in four eyes, and greater than 50% in two eyes. Eight patients received induction therapy with IV ganciclovir or one received induction therapy with foscarnet for a median of 43 days, followed by maintenance therapy with IV or oral ganciclovir for a median of 88 days in six patients (67%).

During a mean follow-up period of 20 months, visual acuity improved in four eyes (28.5%), was stable in four eyes (28.5%), and worsened in six eyes (43%). CMV retinitis recurred in two patients.

 

“The severity of clinical disease at the time of diagnosis may predict poor outcome,” the authors concluded. “Hence, early intervention may be crucial to prevent its progression to irreversible visual loss.”

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