[CIS PIDD] [cis-pidd] Renal transplant in CGD patient with distant h/o aspergillus pneumonia with osteomyelitis

[CIS-PIDD]

I have a 50 y/o  pt with autosomal recessive CGD, who had aspergillus pneumonia  (dx of aspergillus and then CGD were made only after she had resection of RUL for a persistent pneumonia).  The infection spread to contiguous ribs and vertebrae many, many years ago, despite amphotericin doses that compromised her kidney function.  At just that time, both itraconazole and IFN-gamma were IND's , and we started both with a long term cure.  She has been maintained on both drugs for probably 20+ yrs, interrupted only briefly for 2 pregnancies.

She has chronic kidney disease, and is now on the renal transplant list.  The transplant team is not happy with keeping her on IFN, as they think it may increase the rejection risk.  I am very nervous about stopping it, especially in the face of the T-cell immunosuppression that she will need.

Do any of you have experience with solid organ transplants in CGD?  Any other words of wisdom?

Howard
Howard M. Lederman, M.D., Ph.D.
Professor of Pediatrics, Medicine and Pathology
Division of Pediatric Allergy and Immunology
Johns Hopkins Hospital - CMSC 1102
600 N. Wolfe Street
Baltimore, MD 21287-3923
Phone: 410-955-5883
Fax: 410-955-0229
Email: Hlederm1 at jhmi.edu<https://mobile.johnshopkins.edu/OWA/redir.aspx?C=02aee18ab96e42ab8cb61c09ecb79487&URL=mailto%3aHlederm1%40jhem.jhmi.edu>

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