title: The impact of cytomegalovirus infections and acute rejection episodes on the development of vascular changes in 6-month protocol biopsy specimens of cadaveric kidney allograft recipients.
abstract: BACKGROUND
  The role of cytomegalovirus (CMV) in chronic kidney allograft rejection remains controversial. The purpose of this study was to examine the impact of CMV infection on histopathologic changes in 6-month protocol biopsy specimens of kidney allografts.
  
  
  METHODS
  Altogether, 52 renal allograft recipients were studied. CMV infection was diagnosed by CMV antigenemia test, viral cultures from blood and urine, or both. CMV was demonstrated in the biopsy specimens by antigen detection and hybridization in situ. Acute rejections were diagnosed by biopsy histology, and biopsy specimens were graded according to the Banff '97 classification.
  
  
  RESULTS
  CMV infection was diagnosed in 41 patients. The 11 patients in whom CMV infection was not detected were used as controls. Acute rejection was diagnosed in 22 of 41 CMV patients and in 6 of 11 control patients. CMV was demonstrated in the biopsy specimens of 19 of 41 CMV patients. CMV was not associated with increased glomerular, tubular, or interstitial changes. However, the arteriosclerotic changes in small arterioles were significantly increased in the subgroup of patients where CMV was demonstrated in the graft as compared with controls (P<0.01). Analysis of the impact of acute rejection on arteriolar thickening showed that only a positive history of both acute rejection and CMV found in the graft was associated with significantly increased vascular changes compared with CMV-free recipients (P<0.05).
  
  
  CONCLUSIONS
  Neither CMV nor acute rejection alone was associated with increased vascular or other histopathologic changes in 6-month protocol biopsy specimens of kidney allografts, but a previous history of both acute rejection and the presence of CMV in the graft was associated with increased vascular changes.
authors.affiliation: Department of Virology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Helantera
authors.forename: Petri
authors.initials: P
authors.lastname: Koskinen
authors.forename: Tom
authors.initials: T
authors.lastname: Tornroth
authors.forename: Raisa
authors.initials: R
authors.lastname: Loginov
authors.forename: Carola
authors.initials: C
authors.lastname: Gronhagen-Riska
authors.forename: Irmeli
authors.initials: I
authors.lastname: Lautenschlager
mesh_terms: D000328:Adult; D001160:Arterioles / Q000473:pathology / Q000821:virology; D001706:Biopsy; D002908:Chronic Disease; D003586:Cytomegalovirus Infections / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000473:pathology* / Q000821:virology*; D006801:Humans; D007668:Kidney / Q000502:physiology / Q000601:surgery / Q000821:virology; D007674:Kidney Diseases / Q000473:pathology / Q000601:surgery / Q000821:virology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012079:Renal Circulation; D014184:Transplantation, Homologous