A Prospective Study of the Natural Course of Cytomegalovirus Infection and Disease in Renal Allograft Recipients1

Abstract

The incidence of CMV infections in first transplants was 68% in D+R- and D+/-R+ serostatus groups, whereas the incidence of CMV disease was higher in D+R- (56%) than in D+/-R+ (20%, P<0.001). No difference in severity of CMV disease in D+R- and D+/-R+ was seen except for an increased incidence of hepatitis in primary infections. One of 14 deaths could be associated with CMV disease in a seropositive recipient. Cox regression analysis showed that rejection (RR 2.5, P<0.01) and serostatus group D+R- (RR 3.9, P<0.001) were significant risk factors for development of CMV disease. The maximum CMV pp65 antigen count had significant correlation to disease only in CMV seropositive recipients, P<0.001. Conclusion. Renal transplant recipients can safely be given deferred ganciclovir therapy for CMV disease if they are intensively monitored for CMV infection. Patients with primary CMV infection (D+R-), CMV infected patients undergoing anti-rejection therapy and R+ patients with high CMV pp65 counts seem to have a particular potential for benefit from preemptive anti-CMV-therapy.

Asymptomatic cytomegalovirus infection is associated with increased risk of new-onset diabetes mellitus and impaired insulin release after renal transplantation

“…From previous publications it was known that the incidence of new-onset PTDM was about 17% [15], and that approximately 35% of the patients had asymptomatic CMV infection [10]. Taking this into account, the present study had a power of more than 80% (α=0.05) to detect a five-fold increased risk of PTDM in patients with asymptomatic CMV infection, as compared with controls without CMV infection.…”

“…The majority of these patients (n=160) were also closely monitored for CMV infection and CMV disease during the first 3 months after transplantation [10]. Taking into account the objectives of the present study, the 36 patients with CMV disease were excluded, leaving a total of 124 recipients for inclusion in the present analysis.…”

“…On the other hand, both CMV infection and new-onset diabetes are frequently observed in renal transplant recipients [9,10]. Therefore, this group of patients is of particular interest for the study of a potential relationship between CMV and diabetes.…”

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

“…CMV and who receive kidneys from donors who are antibody negative (Table 27) (186). The incidence of primary CMV disease among antibody negative recipients of antibody positive donors is about 50-75% without specific prophylaxis (186,187). The incidence among antibody positive recipients of antibody positive or negative donors is about 25-40% (186,187).…”

“…The incidence of primary CMV disease among antibody negative recipients of antibody positive donors is about 50-75% without specific prophylaxis (186,187). The incidence among antibody positive recipients of antibody positive or negative donors is about 25-40% (186,187). The incidence and severity of CMV disease are also influenced by the amount of immunosuppression used (188)(189)(190)(191).…”