title: Cytomegalovirus infection in renal transplant recipients.
abstract: We have retrospectively analyzed the incidence of cytomegalovirus (CMV) infection in 250 consecutive renal allograft transplants performed in 244 recipients. The mean follow-up was 35.1+/-25.4 months. Immunosuppression was cyclosporine- or tacrolimus-based triple therapy. CMV infection prophylaxis with ganciclovir for 3 months post transplant was prescribed in CMV-seronegative recipients of allografts from seropositive donors (D+R-) and in all recipients treated with OKT3. CMV antigenemia was monitored by the pp65-antigen assay. Thirteen of 57 D+R- recipients (22.8%) developed CMV antigenemia. One recipient had a breakthrough of CMV antigenemia during ganciclovir prophylaxis; 12 D+R- recipients developed CMV antigenemia 147.5+/-173.8 days after transplantation. Four of 13 (30.7%) D+R- recipients had asymptomatic CMV infection, 8 (61.6%) had CMV infection with non-specific symptoms including fever, and 1 (7.7%) developed CMV pneumonia. Six of 13 (46.1%) D+R- patients had been treated with intensified immunosuppressive therapy before CMV infection. In the low-risk CMV groups (D+R+; D-R+; D-R-), 28 recipients (14.5%) developed CMV antigenemia 42.5+/-15.2 days post transplantation. Ten of the 28 (35.7%) recipients had asymptomatic CMV infection, 17 (60.7%) developed CMV infection with non-specific symptoms, and 1 (3.6%) developed CMV pneumonia. Twenty-one of 28 (75.0%) had intensified immunosuppressive therapy before CMV infection. In conclusion, ganciclovir prophylaxis diminished and delayed the onset of CMV infection but did not totally prevent it from occurring in D+R- renal transplant recipients. Clinicians should be vigilant to the possibility of CMV infection in both seronegative and seropositive recipients, especially after anti-rejection therapy.
authors.affiliation: Department of Renal Medicine, Aarhus University Hospital, Skejby Sygehus, Aarhus, Denmark. jcar@farm.au.dk
authors.forename: J
authors.initials: J
authors.lastname: Carstens
authors.forename: H K
authors.initials: HK
authors.lastname: Andersen
authors.forename: E
authors.initials: E
authors.lastname: Spencer
authors.forename: M
authors.initials: M
authors.lastname: Madsen
mesh_terms: D000328:Adult; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006684:HLA-DR Antigens / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D006684:HLA-DR Antigens; D007166:Immunosuppressive Agents; D015774:Ganciclovir