Changing severity of Dengue infection in renal transplant recipients: “Unpredictable and lethal”
Harshit Patel1, Vivek Kute1, Subho Banerjee1, Divyesh Engineer1.
1Nephrology and Transplantation, IKDRC-ITS, Ahmedabad, India
Introduction: Dengue virus belongs to the family Flaviviridae genus Flavivirus and is small, enveloped, single-strand RNA having a genome of positive polarity. It is transmitted by Aedes aegyptia bite. WHO estimated that 500 000 people with severe dengue needs hospitalization per year with 2.5% case fatality, annually. In 2019 India has reported more than 67,000 cases of dengue fever according to data released by the Directorate of the National Vector Borne Disease Control Programme (NVBDCP) & Gujarat reported 5,819 cases of Dengue. With this huge number of cases it was expected to bring cases of dengue infected renal transplants in our center where around 300 transplants are done every year. No published literature about the outcome of Dengue post renal transplant is available after 2015. We report our experience of Dengue infection in a single center, and attempt to detect predictive factors for severe allograft dysfunction in dengue infection.
Methods: This was a prospective observational study in a single center, conducted in IKDRC-ITS, Ahmedabad, Gujarat, India during 2018 to 2019. As per NVBD protocol Dengue fever was treated at home while Dengue with warning signs was hospitalized. We admitted all dengue fever cases as well and treated all Dengue with warning signs with 1ml/kg/hr IVF crystalloid for 24hrs and after reassessment continued for another 24h or 48hrs depending only on the clinical status, irrespective of platelet counts. This is unlike NVBD protocol for Dengue management in India. Dengue with shock were treated as per NVBD protocol. Graft Doppler was done daily to look for any collection.
Results: 20 of the 31 cases developed AKI, and there was no gender predilection In a developing nation where infection is the leading cause of mortality as compared to developed nation, encountering a patient with Dengue can be scary. In our study we observed 100% survival rate in Dengue infection. Anti rejection was not associated with mortality or severity in our study contrary to previous study . Why this varied presentation exists is a huge topic of discussion. May be good outcome studies were infected with avirulent genotype of dengue. The allograft dysfunction in our study group was due to of fever and dehydration and no renal biopsy was done, cytopathic effect was not demonstrated. One graft loss occurred where patient was infected with concomitant CMV. There hasn’t been any published literature regarding effect of concomitant CMV in Dengue, in our study it resulted in dreaded graft loss. One patient got donor derived dengue infection from mother in his immediate post op period, which recovered without any complications.
Conclusion: We found that only leucopenia was associated with AKI, and the dormant course of dengue in our study was a surprise. We conclude that we haven’t yet developed any specific therapy for Dengue nor we can predict its severity in post transplants.
 Prasad et al. Dengue virus infection in renal allograft recipients: a case series during 2010 outbreak. Transpl Infect Dis. 2012 Apr;14(2):163-8
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