title: Late-onset cytomegalovirus reactivation in critically ill renal transplant patients.
abstract: BACKGROUND
  Cytomegalovirus (CMV) reactivation occurs frequently in the first months after renal transplantation. However, reports concerning long-term kidney transplant recipients are rare and have always pertained to symptomatic CMV disease.
  
  
  METHODS
  We report four cases of late-onset asymptomatic CMV reactivation in critically ill renal transplant patients who suffered from severe bacterial infections and in whom CMV antigenemia was observed.
  
  
  CONCLUSIONS
  CMV reactivation in these patients might indicate an additional disturbance in the patients' immune defenses at the time of critical illness, possibly even necessitating a temporary reduction in immunosuppressive therapy. Prospective, controlled trials are needed to define the role of CMV antigenemia in critically ill patients, including the role of antiviral therapy for asymptomatic reactivations.
authors.affiliation: Department of Nephrology and Endocrinology, Benjamin Franklin University Hospital, Free University of Berlin, Berlin, Germany. friederike.jochimsen@ medizin.fu-berlin.de.
authors.forename: Friederike
authors.initials: F
authors.lastname: Jochimsen
authors.forename: Timm
authors.initials: T
authors.lastname: Westhoff
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Engelmann
authors.forename: Jürgen-Heiner
authors.initials: JH
authors.lastname: Schäfer
authors.forename: Gerd
authors.initials: G
authors.lastname: Offermann
authors.forename: Walter
authors.initials: W
authors.lastname: Zidek
mesh_terms: D000208:Acute Disease; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage; D001424:Bacterial Infections / Q000150:complications*; D016638:Critical Illness; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000188:drug therapy; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage; D006801:Humans; D016030:Kidney Transplantation; D008875:Middle Aged; D009504:Neutrophils / Q000821:virology; D010750:Phosphoproteins / Q000032:analysis; D012008:Recurrence; D015163:Superinfection / Q000150:complications; D013997:Time Factors; D014763:Viral Matrix Proteins / Q000032:analysis
chemical_list: D000998:Antiviral Agents; D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa; D015774:Ganciclovir