CYTOMEGALOVIRUS-INFECTION - A QUANTITATIVE PROSPECTIVE-STUDY OF 320 CONSECUTIVE RENAL-TRANSPLANTS

Abstract

The quantitative effects of cytomegalovirus (CMV) infection on morbidity and mortality rates were examined in 320 renal transplant cases. With the use of virus cultures and CMV antibody measurements, all patients were studied, regardless of symptoms, from a time before transplantation to at least 1 yr, 11 mo. after transplantation for a maximum of 5 yr, 9 mo. The posttransplant risk factors of CMV patient age, type of donor (living-related or cadaver), antigen match between donor and recipient, presence of diabetes and the presence of pretransplant CMV antibody-were evaluated for their relative effects on patient survival, graft survival, fever and leukopenia. CMV infection was a significant risk factor for these 4 events. CMV infection occurred in 181 patients after transplantation and accounted for 25% of the deaths, 20% of the graft failures, 30% of the occurrences of fever and 35% of the occurrences of leukopenia. Unexpectedly, female recipients were at higher risk than men for the adverse effects of CMV infection. Young patients and those receiving their 2nd transplant were at higher risk of graft loss if they had associated CMV infection. CMV infection was most reliably predicted by the presence of pretransplant antibody, indicating that reactivation of endogenous virus was responsible for most infections. The presence of pretransplant antibody offered a small amount of protection against fever, but no protection against death, graft failure or leukopenia. Simultaneous episodes of CMV infection and transplant rejection, both common posttransplant events, most often occurred by chance.