Late-acute renal allograft rejection and symptomless cytomegalovirus infection.
The role of cytomegalovirus infection in allograft injury is controversial. A subgroup of renal graft recipients who had histologically proven late-acute rejection did not respond to conventional anti-rejection therapy (80% graft loss within 1 year). These patients showed an expansion of memory-type CD8 peripheral-blood T cells that expressed interferon-gamma mRNA and an association with clinically symptomless cytomegalovirus infection (82% PCR positive, 42% antigenaemia). Antiviral therapy with ganciclovir resulted in stable improved graft function in 17 of 21 treated patients with cytomegalovirus-associated late-acute rejection. The results underline the clinical relevance of cytomegalovirus-related graft injury and offer a novel therapeutic approach.
Reinke
P
P
Medical Clinic V-Nephrology, Universitätsklinikum Charité, Berlin, Germany.
Fietze
E
E
Ode-Hakim
S
S
Prösch
S
S
Lippert
J
J
Ewert
R
R
Volk
H D
HD
D000208:Acute Disease; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000188:drug therapy; D006084:Graft Rejection / Q000209:etiology / Q000276:immunology / Q000628:therapy; D006801:Humans; D016867:Immunocompromised Host; D007156:Immunologic Memory; D016030:Kidney Transplantation; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy; D013601:T-Lymphocytes; D013997:Time Factors