Pulmonary Cytomegalovirus Replication in Renal Transplant Patients with Late Onset Pneumonitis.
BACKGROUND
In renal transplant patients, pneumonitis may be caused by cytomegalovirus (CMV pneumonitis). This condition is usually accompanied by CMV viremia. However, CMV may also reactivate locally in the lungs of renal transplant patients with pneumonitis due to other pathogens. The impact of local CMV replication/reactivation in the lungs is unknown.


METHODS
All renal transplant patients at the Duesseldorf transplant center in the time from 01/2004 to 1/2008 were analyzed concerning pulmonary CMV replication in the setting of pneumonitis.


RESULTS
Of 434 renal transplant recipients, 25 patients were diagnosed with pneumonitis. From these 25 patients with pneumonitis, 7 presented with isolated pulmonary CMV replication but without relevant CMV viremia 8±4.2 months after renal transplantation. Three of the 7 patients needed long-term respiratory support by invasive mechanical ventilation. Pulmonary opportunistic infections were diagnosed in 6 of the 7 patients. Therapy consisted of a reduction in immunosuppression, ganciclovir, and antibiotics.


CONCLUSIONS
Our findings suggest that pulmonary CMV replication occurs in renal transplant patients with pneumonitis even at later phases after renal transplantation. This finding seems to be a frequent complication (7/25 patients). Clinicians should be aware of this condition because blood-based screening assays for CMV will remain negative.
Department of Nephrology, University Hospital Duesseldorf, Heinrich-Heine University, Duesseldorf, Germany.
Eva
E
Königshausen
Institute of Virology, University Medical Center, Albert-Ludwigs-University Freiburg, Freiburg, Germany.
Hartmut
H
Hengel
Institute of Virology, University Hospital, Heinrich-Heine-University, Duesseldorf, Germany.
Ortwin
O
Adams
Department of Nephrology, University Hospital, Heinrich-Heine-University, Duesseldorf, Germany.
Heinz
H
Bry
Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg, Germany.
Stephan
S
Steiner
Institute of Pneumology, Hospital Bethanien, University Witten/Herdecke, Solingen, Germany.
Christina
C
Priegnitz
Department of Nephrology, University Hospital, Heinrich-Heine-University, Duesseldorf, Germany.
Anita
A
Hansen
Department of Nephrology, University Hospital, Heinrich-Heine-University, Duesseldorf, Germany.
Lorenz
L
Sellin
Department of Nephrology, University Hospital, Heinrich-Heine-University, Duesseldorf, Germany.
Lars C
LC
Rump
Department of Nephrology, Brigham and Women's Hospital, Boston, MA, USA.
Adina
A
Voiculescu
D000328:Adult; D003587:Cytomegalovirus / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000209:etiology* / Q000276:immunology / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation; D008168:Lung / Q000821:virology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011024:Pneumonia, Viral / Q000209:etiology* / Q000276:immunology / Q000821:virology; D011183:Postoperative Complications / Q000276:immunology / Q000821:virology*; D012189:Retrospective Studies; D014779:Virus Replication