Herpes simplex esophagitis after renal transplantation

Area of Science:

• Nephrology
• Infectious Diseases
• Transplant Surgery

Background:

• Renal transplant recipients often undergo intensive immunosuppressive therapy to prevent organ rejection.
• Opportunistic infections, such as herpes simplex virus (HSV) infections, are a significant concern in this patient population.
• Esophagitis, an inflammation of the esophagus, can be caused by various pathogens, including HSV.

Purpose of the Study:

• To describe the occurrence and clinical presentation of herpes simplex esophagitis in renal transplant recipients.
• To identify risk factors and optimal management strategies for this opportunistic infection.
• To evaluate the efficacy of acyclovir in treating herpes simplex esophagitis in this cohort.

Main Methods:

• Retrospective analysis of 221 consecutive renal transplant recipients.
• Identification of five patients who developed herpes simplex esophagitis.
• Review of clinical presentation, endoscopic findings, diagnostic methods (biopsies, cultures), treatment, and outcomes.

Main Results:

• Five out of 221 renal transplant recipients developed herpes simplex esophagitis, presenting as odynophagia and/or dysphagia.
• The infection occurred during or shortly after treatment for acute cellular rejection with high-dose steroids and, in four cases, anti-lymphocyte globulins.
• All patients responded well to intravenous acyclovir treatment.

Conclusions:

• Herpes simplex esophagitis is an opportunistic infection that can occur in renal transplant recipients experiencing intensive immunosuppression.
• Variable endoscopic findings necessitate biopsies and cultures for accurate diagnosis.
• Prevention strategies may include donor-recipient serologic matching and prophylactic oral acyclovir.