Clinical pattern, risk factors, and outcome of CMV infection in renal transplant recipients: local experience

Clinical Manifestation, Laboratory Findings, and the Response of Treatment in Kidney Transplant Recipients With CMV Infection

OBJECTIVES

To report clinical manifestations, laboratory findings, and treatment outcomes of in kidney transplant recipients who had cytomegalovirus (CMV) infections.

METHODS

This retrospective study evaluated the records of kidney transplant recipients followed regularly from 2001 to 2006. In some patients information was also gathered through a telephone call or physical examination. The CMV infection diagnosis was also made by detecting PP.65 antigen per 50,000 peripheral blood leukocytes.

RESULTS

Of the 200 kidney transplant recipients, 66 were infected with CMV including 42 men and 24 women. The mean patient age was 40 +/- 13 years (range, 14 to 67 years). Seventy-nine percent of the infected patients were diagnosed during the first 6-months after transplantation. All except 22 patients (33%) had constitutional complaints. Fever was present in 65% of patients, abdominal pain in 21%, diarrhea in 20%, and vomiting in 15%. Likewise, pulmonary complaints including cough and dyspnea were reported by 32% and 23%, respectively. However, 20% of patients were completely asymptomatic. Hematologic laboratory data showed anemia (64%), thrombocytopenia (47%), and leukopenia (21%). Seventy eight percent of patients had a serum creatinine <or=2 mg/dL before infection, but it was <or=2 in just 26% at the time CMV was diagnosed and 60% after treatment. Antiviral therapy included intravenous gancyclovir in 80% of patients and gancyclovir plus oral acyclovir in 20%. Corticosteroid pulse therapy was also administered in 78% of patients. No statistically significant correlation was observed between CMV antigen load and the severity of clinical manifestations or the time of response to treatment or the recurrence prognosis. In our series, 1 patient died, 28 treated patients (42%) experienced CMV recurrence, and 37 (56%) showed no recurrence.

CONCLUSIONS

CMV infection should be considered in any renal transplant recipient who has a rise in creatinine even if symptom-free. Despite the results of other studies, we found no prognostic value for the viral antigen load.

Cytomegalovirus disease latent and active infection rates during the first trimester after kidney transplantation

Cytomegalovirus (CMV) infection is the single most frequent infectious complication in renal transplant recipients. The aim of this study was to determine the incidence of latent and active infections with CMV during the first 3 months after kidney transplantation. From January 2000 to December 2001, 203 consecutive adult renal transplant recipients underwent weekly measurements of pp65 CMV antigen from the 4th to the 12th posttransplantation week. Latent infection (seropositivity) was found in 92% of the population. Primary infection occurred in 4.9% (10 of 203), among whom 66% were previously seronegative patients. Among the primary infection patients, 70% (7 of 10) developed severe disease. The overall incidence of viremia was 69.5%, being more frequent among cadaver recipients (79% vs 59%; P =.02). The overall incidence of CMV disease was 38.4% (78 of 203) with 24.6% classified as severe disease requiring antiviral therapy. In conclusion, our population showed a high prevalence of latent infection with viremia. Not all patients developed clinical disease. Most subjects experienced a mild spectrum of symptoms, probably due to the prospective search for active infection during the major risk period after kidney transplantation.