PROSPECTIVE STUDY OF THE PREVALENCE AND SYMPTOMATOLOGY OF CYTOMEGALOVIRUS INFECTION IN RENAL TRANSPLANT RECIPIENTS

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Abstract
SUMMARY To determine the incidence and symptomatology of cytomegalovirus (CMV) infection in renal transplant recipients, we followed 40 patients prospectively for 5 to 24 months after operation. As judged by the serological change and virus isolation from blood and/or urine, the infection rate for the entire group was 82% (33 of 40 patients). Two types of infection were recognized: primary infection that occurred in 3 patients, and reactivation infection that occurred in 30 patients. Twenty-one patients were asymptomatic and 12 were mildly symptomatic. Four had mild hepatic dysfunction; two had the CMV mononucleosis syndrome associated with mild to moderate deterioration of renal function. Two patients had hyperglycemia. One patient who reached a CMV antibody titer of 1:32,768 was totally asymptomatic other than fever of short duration. CMV-induced pneumonitis or retinitis was not noted, and there was no mortality from CMV infection in our patients. Factors which may be associated with the absence of severe manifestations of active CMV infection in these patients are discussed Many virus diseases have a wide spectrum of clinical manifestations, with mild subclinical infection at one extreme and severe life-threatening illness at the other. This is true of CMV infection in renal transplant recipients. The high incidence of CMV infection in renal transplant patients is well documented (1-4). The incidence has variously been reported from 52 to 96%. We have previously reported, from another center, an incidence of 96% (1). In seronegative patients with no prior evidence of infection with CMV, infection is thought to be transmitted exogenously, i.e., from the allograft itself or from blood transfusions. Immunosuppressive drugs may contribute to infection by facilitating reactivation or primary infection, but their relative importance in these two types of infection is unknown. The common and incidental finding of CMV in asymptomatic patients after transplantation has led many to believe that this ubiquitous infection is just an incidental finding of no consequence. Contrary to this view, there are reports of severe hepatitis, retinitis, pneumonitis, and even death (3). We studied our patients prospectively to determine the incidence and severity of CMV infection and have analyzed the results in an attempt to discover reasons for the differences in incidence and severity that have been observed at other centers

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