title: Intragraft cytomegalovirus protein expression is associated with reduced renal allograft survival.
abstract: BACKGROUND
  Cytomegalovirus (CMV) infection is a risk factor for acute and chronic rejection of transplanted organs and is thought to mediate rejection indirectly.
  
  
  METHODS
  In this retrospective observational cohort study, early- and end-stage biopsies from renal allografts lost because of chronic allograft dysfunction (n = 29) were examined for CMV antigens and DNA using immunohistochemistry, in situ hybridization, and real-time polymerase chain reaction.
  
  
  RESULTS
  CMV immediate-early and late proteins were present in 27 (93%) of 29 of the end-stage chronic allograft dysfunction biopsies and in 64% of the corresponding early biopsies but not in pretransplant biopsies from CMV-seronegative donors (n = 3). Graft survival time was reduced in patients with moderate or high CMV levels in the graft soon after transplantation compared with that in patients with no or low CMV levels in the graft. No significant difference was observed in serum creatinine obtained at the time of early biopsies.
  
  
  CONCLUSIONS
  We provide evidence that intragraft CMV protein expression is associated with end-stage chronic renal allograft dysfunction, that intragraft CMV levels increase as graft function deteriorates, and that CMV protein expression in the grafts soon after transplant is associated with reduced graft survival. Thus, CMV may have a pathological role in chronic renal allograft dysfunction.
authors.affiliation: Department of Medicine, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Mensur
authors.initials: M
authors.lastname: Dzabic
authors.forename: Afsar
authors.initials: A
authors.lastname: Rahbar
authors.forename: Koon-Chu
authors.initials: KC
authors.lastname: Yaiw
authors.forename: Mansour
authors.initials: M
authors.lastname: Naghibi
authors.forename: Piotr
authors.initials: P
authors.lastname: Religa
authors.forename: Bengt
authors.initials: B
authors.lastname: Fellström
authors.forename: Erik
authors.initials: E
authors.lastname: Larsson
authors.forename: Cecilia
authors.initials: C
authors.lastname: Söderberg-Nauclér
mesh_terms: D000328:Adult; D003587:Cytomegalovirus / Q000235:genetics* / Q000378:metabolism; D003586:Cytomegalovirus Infections / Q000150:complications*; D004279:DNA, Viral; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000473:pathology / Q000821:virology; D014184:Transplantation, Homologous; D014764:Viral Proteins / Q000235:genetics / Q000378:metabolism*
chemical_list: D004279:DNA, Viral; D014764:Viral Proteins