Dengue in renal transplant recipients: Clinical course and impact on renal function

Table 1 Characteristics of kidney transplant patients with dengue diagnosis in the period from January 2007 to July 2012 n (%)

Characteristics	n = 11
Age in years-mean (variation)	41.3 (19-61)
Female gender	7 (63.3)
Transplant time in years - mean (variation)	3.6 (1 mo-9 yr)
Deceased donor	9 (82.0)
Thymoglobulin induction	4 (36.6)
Immunosuppressive regimens
PRED + TAC + MMF	4 (36.3)
PRED + CYA + AZA	2 (18.1)
PRED + TAC + MPS	2 (18.1)
TAC + MMF	1 (9.0)
PRED + AZA + SRL	1 (9.0)
CYA	1 (9.0)
Rejection before dengue	3 (27.2)
Clinical findings
Fever	11 (100.0)
Myalgia	10 (91.0)
Headache	6 (54.5)
Abdominal pain	3 (27.2)
Bleedings	3 (27.2)
Nauseas and vomiting	2 (18.1)
Postural hypotension	2 (18.1)
Pleural effusions	2 (18.1)
Laboratory outcomes
Thrombocytopenia	9 (81.8)
Severe Thrombocytopenia (< 50000/mm3)	4 (36.6)
Leucopenia	4 (36.6)
Hemoconcentration	4 (36.6)
Transaminases increase (AST;ALT)	7 (63.6)
AST value, mean (variation) UI/L	130 (17-360)
ALT value, mean (variation) UI/L	100 (14-230)
Hospitalization	9 (81.8)
Hospitalization time in d, mean(variation)	14.2 (3-45)
Classification of dengue cases
Classical dengue	9 (81.8)
DHF	2 (18.1)
Dengue with complication	0

PRED: Prednisone; TAC: Tacrolimus; MMF: Mycophenolate mofetil; CYA: Cyclosporine; AZA: Azathioprine; MPS: Mycophenolate sodium; SRL: Sirolimus; AST: Aminotransferase alanine; ALT: Aminotransferase aspartate; DHF: Dengue hemorrhagic fever.

Table 2 Clinical and kidney graft evolution of 11 kidney transplant patients with dengue n (%)

Characteristics	n = 11
Resolution of symptoms	11 (100)
Death	0
Time for resolution of symptoms in d, mean (variation)	9 (2-20)
Creatinine before dengue, mean(variation)	1.35 mg/dL (0.8-2.2)
Increase of creatinine > 20% and < 50% of baseline	3 (27.2)
Increase of creatinine > 50% of baseline	3 (27.2)
Creatinine after dengue, mean (variation) mg/dL	1.1 (0.8-1.7)
Creatinine 1 mo after dengue, mean (variation) mg/dL	1.3 (0.8-1.8)

Table 3 Characteristics of kidney transplant patients diagnosed with dengue, from January 2007 to July 2012

	Patient
	1	2	3	4	5	6	7	8	9	10	11
Age	52	58	58	61	31	41	25	32	41	19	36
Gender	Female	Male	Male	Female	Female	Male	Male	Female	Female	Female	Female
Pre-Tx baseline diseases	CGN	CGN+HN	FSG	DN	M G	IN	FSG	SEL	HN	BWT	DN
Tx period until dengue	1 yr	10 mo	1 mo	4 mo and a half	3 yr	3 yr and 6 mo	7 yr	2 yr and a half	5 yr	7 yr and 8 mo	9 yr
Kind of donator	Deceased	Deceased	Deceased	Deceased	Deceased	Deceased	Deceased	Alive	Deceased	Alive	Deceased
Induction	Thymoglobulin + methyl-prednisolone	Basiliximab + methyl-prednisolone	Thymoglobulin + methyl-prednisolone	Thymoglobulin + methyl-prednisolone	Thymoglobulin + methyl-prednisolone	Basiliximab + methyl-prednisolone	Methyl-prednisolone	Basiliximab + methyl-prednisolone	Methyl-prednisolone	Methyl-prednisolone	Methyl-prednisolone
IMS drugs on use (during dengue period)	T + M + P	P + C + A	T + M + P	T + M	T + M + P	P + C + A	T + M + P	T + M + P	T + M + P	P + A + S	C
Dengue symptoms	Fever, myalgia, headache	Fever, myalgia	Fever, myalgia, abdominal pain, bleedings (enter-orrhagia)	Fever, myalgia, headache	Fever, headache, abdominal pain	Fever, myalgia	Fever, myalgia, headache, hypotension, postural hypotension	Fever, myalgia, headache, vomiting, abdominal pain	Fever, myalgia, hypotension, postural hypotension	Fever, myalgia, headache	Fever, myalgia, vomiting
Bleeding	No	No	Yes	No	No	No	Yes	No	Yes	No	No
Dengue diagnosis	IgM+	IgM+	IgM+	IgM+	IgM+	IgM+	IgM+	IgM+ and serum PCR	IgM+	IgM+	IgM+
Hemoconcentration	Yes	No	No	No	No	Yes	Yes	No	Yes	No	No
Pleural effusions	Yes	No	No	No	No	No	No	No	Yes	No	No
Hospitalization time	3 d	None	15 d	8 d	13 d	None	1 mo and a half	4 d	20 d (ICU)	10 d	10 d
Evolution	Symptom resolution in 3 d	Symptom resolution in 20 d	Symptom resolution in 15 d	Symptom resolution in 8 d	Symptom resolution in 5 d	Symptom resolution in 6 d	Symptom resolution in 16 d	Symptom resolution in 2 d	Symptom resolution in 5 d	Symptom resolution in 10 d	Symptom resolution in 8 d
Baseline creatinine before dengue	1	1.1	2	1.1	2.2	0.85	1.4	1.45	1.6	1.25	1
Maximum creatinine throughout dengue	2	1.2	2	1.1	2.2	1	10	1.8	3.3	2.1	1.4
Creatinine immediately after dengue	1	1.175	1.5	1.1	1.75	0.85	1.6	1.55	1.5	1.5	1.2
Creatinine 1 mo after dengue	0.9	1.2	1.7	0.8	1.7	0.8	1.8	1.5	1.8	1.6	1

Tx: Transplant; IMS: Immunosuppressive; PCR: Polymerase chain reaction; ICU: Intensive care unit; CGN: Chronic glomerulonephritis; HN: Hypertensive nephropathy; DN: Diabetic nephropathy; FSG: Focal segmental glomerulo-sclerosis; EL: Systemic eritematous Lupus; MG: Mesangiocapillary glomerulonephritis; IN: IgA nephropathy; BWT: Bilateral Wilms Tumor; T: Tacrolimus; M: Mycophenolate; P: Prednisone; C: Cyclosporine; A: Azathioprine; S: Sirolimus.