Korean J Transplant.  2022 Nov;36(Supple 1):S181. 10.4285/ATW2022.F-3065.

Cytomegalovirus reactivation after chemotherapy in a kidney transplant recipient with breast cancer: a case report

• Thammathiwat T
• Pichitsiri W
• Sirilak S
• Kongtal N
• Chompuk L
• Udomkarnjananun S

• KMID: 2535697
• DOI: http://doi.org/10.4285/ATW2022.F-3065

Abstract

Background
Late-onset cytomegalovirus (CMV) reactivation after kidney transplantation (KT) is associated with donor and recipient (D/R) CMV serostatus, shorter courses of immunosuppressive (IS), higher levels of IS medications, and allograft rejec-tion. However, chemotherapy (CMT) that impairs the recipients immune surveillance is another under-reported risk factor.
Methods
We report a case of KTR who had received breast cancer CMT and CMV reactivation was detected during the evaluation of allograft dysfunction. We investigated the cause of allograft dysfunction and CMV reactivation as presented in this case report.
Results
A 74-year-old female underwent living-related KT 20 years ago. The human leukocyte antigen (HLA A-B-DR) mismatch was 1-1-0. The recipient received basiliximab as induction therapy. Cyclosporin and mycophenolate mofetil (MMF) were used for the maintenance regimen. CMV IgG serostatus of the D/R were both positive. The posttransplant clinical course was normal. Last year, the recipient was diagnosed with stage1c breast cancer. Modified radical mastectomy of the left breast was done, followed by an adjuvant CMT consisting of Adriamycin and cyclophosphamide. Three months after CMT, serum creatinine (sCr) was increased from baseline of 1.5 to 2.0 mg/dL. Serum BK viral load and donor-specific anti-HLA antibody were not detected. CMV viral load was found to be 327,000 copies/mL (log 5.51). There was neither leukopenia nor liver function test abnormalities. A kidney allograft biopsy was performed which showed 50% IFTA without evidence of rejection or active inflammation. The im-munohistostaining for CMV and SV40 were negative. Because of CMV viremia, MMF was decreased from 3 to 1.5 g/day and hy-dration was advised. Two months later, plasma CMV viral load became undetectable without any anti-viral initiation, and sCr was returned to the baseline.
Conclusions
A very late-onset CMV reactivation can occur after immunosuppressed KT recipients receive additional CMT. CMT should be recognized as another uncommon risk factor of CMV reactivation and prompt decreasing of immunosuppression may help in the treatment of CMV infection.