The Clinical Significance of Cytomegalovirus Infection in Renal Transplant Recipients

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Abstract
Cytomegalic cells resulting from cytomegalovirus infection were found in the lungs of 27 of 51 (52 percent) autopsied renal transplant recipients. In 8 of these 27 patients cytomegalic cells were also found in various other organs of the body. The finding of distinctive multiple small nodular lesions on chest x-ray correlated with the presence of cytomegalic cells in the lungs at autopsy. Cytomegalic cells were found in the kidney of 1 of the 51 autopsied cases and in the renal biopsy specimens of 1 of 33 survivors. In contrast cytomegalo-viruria was demonstrated by tissue culture methods in 17 of 26 (65 percent) of survivors tested. The titers of virus in the urine ranged from 102. 5 to l03. 5 TCID50/ml. Virus excreted in the urine was largely in the free form rather than cell-associated. Cytomegalovirus -neutralizing antibody was found in the serum specimens from one patient in which the complement-fixation reaction with this antigen was negative. Urine specimens were suitable virus preparations for neutralization studies. Pneumonia in 3 patients was associated with a rise in cytomegalovirus antibody titer. The pre-illness serum specimen in all 3 cases was free of cytomegalovirus complement-fixing antibody and in the one case studied was also free of neutralizing antibody. Rejection in 2 patients and recurrent herpes zoster in 1 patient was associated with a rise in cytomegalovirus complement-fixing antibody titer. Pre-illness antibody was present in the sera of 2 of these 3 cases in contrast to the serologic findings in the pneumonia cases. The relative roles of primary infection versus reactivation of a latent agent in the pathogenesis of these various clinical syndromes is discussed on the basis of these findings.