title: The impact of cytomegalovirus infection on seronegative recipients of seropositive donor kidneys versus seropositive recipients treated with cyclosporine-prednisone immunosuppression.
abstract: To assess the impact of cytomegalovirus (CMV) infection in D+R- patients treated with cyclosporine (CsA)-prednisone immunosuppression, we compared the incidence of CMV infection, severity of disease, and the 1, 2, and 3-year actual graft and patient survival rates of CMV-infected D+R- patients with R+ patients from a group of 516 renal allograft recipients at our center. CMV infection occurred more frequently in 27/56 D+R- patients (48%) versus 111/376 R+ patients (29%) (P less than 0.01). The incidence of CMV was also significantly greater in D+R- versus R- patients receiving CAD grafts (59% vs. 32%, P less than 0.01) and first transplants (47% vs. 30%, P less than 0.05). There were no significant differences in CMV disease severity between the aggregate D+R- and R+ patient groups and when subgroups of these patients receiving cadaveric donor (CAD), living-related donor (LRD), first, or retransplant allografts were compared. The actual 1, 2, and 3-year graft survival rates for D+R- patients (68%, 58%, 68%) were not significantly different from rates in R+ patients (83%, 77%, 63%) with CMV infection. When the 1, 2, and 3-year actual graft survival rates in subgroups of D+R- and R+ patients were compared in CAD, LRD, and first and retransplants, there were no significant differences. The actual 1, 2, and 3-year patient survival rates were not significantly different between D+R- (89%, 92%, 100%) and R+ patients (94%, 91%, 86%) with CMV infection, nor were they different when CMV infected D+R- and R+ patients with CAD, LRD, first or retransplant grafts were compared. These data do not support the policy of denying a seropositive kidney to a seronegative recipient, since the severity of CMV disease and the impact of CMV infection is not significantly different comparing D+R- and R+ patients receiving CsA-prednisone immunosuppression.
authors.affiliation: Department of Internal Medicine, University of Texas Health Science Center, Houston 77030.
authors.forename: P C
authors.initials: PC
authors.lastname: Johnson
authors.forename: R M
authors.initials: RM
authors.lastname: Lewis
authors.forename: D L
authors.initials: DL
authors.lastname: Golden
authors.forename: P E
authors.initials: PE
authors.lastname: Oefinger
authors.forename: C T
authors.initials: CT
authors.lastname: Van Buren
authors.forename: R H
authors.initials: RH
authors.lastname: Kerman
authors.forename: B D
authors.initials: BD
authors.lastname: Kahan
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003524:Cyclosporins / Q000008:administration & dosage / Q000009:adverse effects*; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000209:etiology* / Q000635:transmission; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects*; D012086:Reoperation
chemical_list: D000914:Antibodies, Viral; D003524:Cyclosporins; D011241:Prednisone