title: Sequential cytomegalovirus antigenemia monitoring in kidney transplant patients treated with antilymphocyte antibodies.
abstract: BACKGROUND
  Antilymphocyte antibodies (ALA) use is related to disseminated cytomegalovirus (CMV) disease after kidney transplantation. Strict surveillance of CMV infection, preemptive antiviral treatment or concomitant ganciclovir and ALA use are proposed as an attempt to prevent related clinical complications. Our objective was to describe the pattern of CMV infection, based on sequential antigenemia detection, after ALA treatment.
  
  
  METHODS
  Thirty renal transplant patients were prospectively screened for CMV infection after ALA treatment. CMV antigenemia (pp65 antigen detection) was monitored twice a week in the first month and weekly until 60 days after the beginning of ALA therapy. Any positive value of antigenemia was considered CMV infection.
  
  
  RESULTS
  Twenty-eight (93.3%) patients were CMV positive (IgG) before transplantation. The mean duration of ALA treatment was 12.1+/-2.4 days. Positive antigenemia was detected in 24 (80%) patients, a mean of 52.5+/-15 days after transplant and 44.7+/-14 days after the beginning of ALA treatment. The median antigenemia count was 7 positive cells/300,000 neutrophils (range: 1-227). Antigenemia preceded clinical symptoms by 5.8 days (0-28 days). Eighteen (75%) of 24 positive patients received ganciclovir treatment: 8 patients (26.7%) for viral syndrome, 2 patients (33.3%) for invasive disease, and 8 patients (26.7%) as part of preemptive therapy, asymptomatic with high antigenemia values. Six pp65-positive patients with low counts were followed up until a negative result and remained asymptomatic without any specific treatment.
  
  
  CONCLUSIONS
  CMV infection was frequent after ALA treatment in this group and generally occurred late after completion of treatment. Antigenemia was a reliable tool to guide preemptive treatment in these patients, and such strategy is an alternative option compared to the prophylactic use of ganciclovir with ALA treatment.
authors.affiliation: Division of Nephrology, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, Brazil.
authors.forename: K S
authors.initials: KS
authors.lastname: Ozaki
authors.forename: J O M
authors.initials: JO
authors.lastname: Pestana
authors.forename: C F H
authors.initials: CF
authors.lastname: Granato
authors.forename: A
authors.initials: A
authors.lastname: Pacheco-Silva
authors.forename: L F A
authors.initials: LF
authors.lastname: Camargo
mesh_terms: D000328:Adult; D000961:Antilymphocyte Serum / Q000008:administration & dosage* / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000821:virology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010750:Phosphoproteins / Q000097:blood*; D013997:Time Factors; D014763:Viral Matrix Proteins / Q000097:blood*
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa