Blurred Vision After a Kidney Transplant

JAMA Ophthalmology Published online April 6, 2023

中文摘要

這篇文章報導了一名三十幾歲的腎移植病人，在罹患巨細胞病毒（CMV）網膜炎並於視網膜發現多個 cotton wool spots後，接受多種治療而未獲改善，最後轉而使用 multivirus-specific cytotoxic T-lymphocyte (CTL, 多病毒特異性細胞毒性T細胞治療）。CTL是一種免疫療法，透過接受來自供者的T細胞以提供病毒特異性免疫反應以清除感染。此病例接受了Posoleucel，一種多病毒特異性T細胞療法，治療後眼睛和CMV指標的情況都有明顯改善。然而，病人在治療後八週回診時出現視力下降和視網膜水腫的症狀。最終，病人因移植後淋巴增生性疾病的併發症而轉入安寧療護，並未能進一步驗證視力下降的原因。此研究表明，CTL是一種有前途的新型療法，需要進一步的研究，特別是在前瞻性試驗中評估其在CMV網膜炎治療中的作用。

English Abstract

This article discusses a case study of a patient who experienced blurred vision after receiving a kidney transplant. The patient had a medical history of deceased donor kidney transplant, cytomegalovirus (CMV) colitis, and CMV viremia with documented resistance to foscarnet and ganciclovir. Clinical examination revealed multiple cotton wool spots along the arcades and periphery, and granular, hypopigmented retinal lesions without hemorrhage in the macula and temporal periphery in both eyes. Despite the patient’s documented UL97 and UL54 mutations, a series of five biweekly intravitreal injections of foscarnet and ganciclovir were performed, given their vision-threatening lesions, but retinal pathology failed to improve. The patient eventually refused additional intravitreal therapy because of pain and transiently decreased vision after each injection. The patient then received multivirus-specific cytotoxic T-lymphocyte (CTL) therapy, with dramatic improvement in both retinal findings and CMV titers one month after the first infusion. Unfortunately, before any additional testing could occur, the patient rapidly declined from complications of posttransplant lymphoproliferative disorder and transitioned to hospice. CTL therapy is a promising novel therapy that requires further investigation, ideally with prospective trials, to evaluate its role in the treatment of CMV retinitis.