title: The impact of pretransplant cytomegalovirus infection on acute renal allograft rejection.
abstract: BACKGROUND
  The role of cytomegalovirus (CMV) infection in renal allograft rejection remains controversial; moreover, there are few studies on pretransplant infections. This study sought to investigate whether pretransplant CMV infections had negative effects on acute rejection episodes (ARE) and to evaluate the effect of preemptive treatment.
  
  
  METHODS
  This retrospective single-center study of 416 transplant recipients from October 1, 2000 to September 1, 2003 had CMV infections diagnosed by CMV antigenemia tests. The incidences of ARE were compared between CMV-infected and noninfected groups. Risk factors for ARE were analyzed. Based on preemptive treatment, pretransplant CMV-infected recipients were divided into ganciclovir-treated and nontreated groups and the incidence of ARE was compared between the two groups.
  
  
  RESULTS
  One hundred eighty four recipients had CMV infections pretransplant; the infection rate was 44.2%. Fifty five recipients had ARE among the pretransplant CMV-positive group, which was significantly higher than that in the noninfected group (29.9% vs 19.5%, P = .014). But the rejection subgroups and renal function recovery had no significant differences. While the presence of pretransplant infection was an independent predictor of ARE (RR = 1.807), severity showed no significant impact on ARE. Among 184 pretransplant CMV infection recipients, the incidences of ARE were 14.3% and 18.0% in ganciclovir-treated versus nontreated patients, respectively (P = .650).
  
  
  CONCLUSIONS
  Pretransplant CMV-positive recipients were at greater risk of ARE. Pretransplant CMV infection was an independent risk factor for ARE. Preemptive antiviral treatment did not show protective effects against ARE related to CMV infection-mediated immunological injuries.
authors.affiliation: Kidney Disease Center, the First Affiliated Hospital of Medical College, Department of Nephrology, Medical College of Zhejiang University, Hangzhou, Zhejiang, People's Republic of China. zykidney@mail.hz.zj.cn
authors.forename: J H
authors.initials: JH
authors.lastname: Chen
authors.forename: Y Y
authors.initials: YY
authors.lastname: Mao
authors.forename: Q
authors.initials: Q
authors.lastname: He
authors.forename: J Y
authors.initials: JY
authors.lastname: Wu
authors.forename: R
authors.initials: R
authors.lastname: Lv
mesh_terms: D000208:Acute Disease; D000328:Adult; D002102:Cadaver; D003586:Cytomegalovirus Infections / Q000150:complications*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology* / Q000821:virology; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000145:classification / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery / Q000821:virology; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000821:virology; D012044:Regression Analysis; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome