title: Impact of CMV infection on acute rejection and long-term renal allograft function: a systematic analysis in patients with protocol biopsies and indicated biopsies.
abstract: BACKGROUND
  Higher rates of acute rejection (AR) and reduced graft survival have been reported in patients with cytomegalovirus (CMV) infection, but an association between these factors remains controversial.
  
  
  METHODS
  In this study, serial protocol biopsies (PBs) and clinically indicated biopsies (IBs) from a large cohort of renal allograft recipients (n &frac14; 594) were analyzed to examine the relation between CMV and AR.
  
  
  RESULTS
  Patients with CMV were more likely to receive IB (85 of the 153 patients; 56%) compared to patients without CMV (138 of 441 patients; 32%; P = 0.003). However, this did not translate into a greater number of patients with episodes of acute cellular rejection on histopathology in IBs. Analysis of PBs revealed a significantly higher number of episodes of rejection per patient with CMV infection (P = 0.04), but only in a subgroup of patients with triple immunosuppression. Long-term graft function post-transplantation was analyzed in four different subgroups according to CMV infection and/or AR. Differences in renal function were apparent within the first 6 weeks after transplantation and persisted during follow-up, with the best renal function in patients without AR or CMV, whereas patients with both AR and CMV had the worst (P < 0.012 at 1 year; P < 0.001 at 2 years). On average, the latter group had significantly older donors and more often delayed graft function.
  
  
  CONCLUSIONS
  Our data suggests that the link between CMV and AR is far less significant than previously thought. Outcome in patients with CMV may be more determined by coexisting conditions like high donor age and delayed graft function.
authors.affiliation: Division of Nephrology and Hypertension, University of Virginia, Charlottesville, VA, USA. ue2u@virginia.edu
authors.forename: Uta
authors.initials: U
authors.lastname: Erdbruegger
authors.forename: Irina
authors.initials: I
authors.lastname: Scheffner
authors.forename: Michael
authors.initials: M
authors.lastname: Mengel
authors.forename: Anke
authors.initials: A
authors.lastname: Schwarz
authors.forename: Willem
authors.initials: W
authors.lastname: Verhagen
authors.forename: Hermann
authors.initials: H
authors.lastname: Haller
authors.forename: Wilfried
authors.initials: W
authors.lastname: Gwinner
mesh_terms: D001706:Biopsy; D003587:Cytomegalovirus / Q000472:pathogenicity; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000401:mortality / Q000821:virology; D051799:Delayed Graft Function / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery / Q000821:virology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous