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Renal transplant and cytomegalovirus infection: experience in a community hospital program
W S Matulis1, G Cokeley, M Matulis
1Section of Infectious Diseases, West Virginia University School of Medicine, Charleston.
Abstract:
Cytomegalovirus (CMV) is the most frequently occurring opportunistic pathogen and single most important infectious agent in renal transplant recipients, contributing significantly to their morbidity and mortality. Infection generally occurs in the first four months after transplant and develops in about two-thirds of these patients overall. Cytomegalovirus infection may occur as a primary disease, a reactivation, or as a superinfection and may encompass a spectrum of diseases ranging from asymptomatic to fatal. This study reviews CMV donor and recipient status, prophylaxis, rejection episodes, immunosuppression and subsequent development of disease in 100 transplant cases in 98 patients which were performed at the charleston Area Medical Center between September 1987 and August 1991, and contrasts these findings to those from larger centers. Sixty-five recipients were positive for cytomegalovirus serologically at the time of transplantation, and of the 35 patients who were CMV negative, 20 received a kidney from a CMV-positive donor and a total of six patients have developed symptomatic disease to date.
Insights
Cytomegalovirus (CMV) significantly impacts renal transplant recipients, causing serious illness. This study analyzed CMV status, prophylaxis, and immunosuppression in 98 patients to understand disease development post-transplant.
Area of Science:
- Nephrology
- Infectious Diseases
- Transplant Immunology
Background:
- Cytomegalovirus (CMV) is a major opportunistic pathogen in renal transplant recipients, leading to significant morbidity and mortality.
- CMV infection, occurring as primary disease, reactivation, or superinfection, affects approximately two-thirds of patients within four months post-transplant.
- The spectrum of CMV disease ranges from asymptomatic to fatal complications.
Purpose of the Study:
- To review Cytomegalovirus (CMV) donor and recipient status, prophylaxis, rejection episodes, and immunosuppression.
- To analyze the subsequent development of CMV disease in renal transplant recipients.
- To contrast findings from a single center with data from larger transplant centers.
Main Methods:
- Retrospective review of 100 renal transplant cases in 98 patients performed between September 1987 and August 1991.
- Analysis of CMV serological status in both donors and recipients at the time of transplantation.
- Tracking of CMV disease development, prophylaxis, rejection episodes, and immunosuppression protocols.
Main Results:
- Sixty-five (65%) of the 98 recipients were serologically positive for CMV pre-transplant.
- Of the 35 CMV-negative recipients, 20 received kidneys from CMV-positive donors.
- Six patients developed symptomatic CMV disease to date.
Conclusions:
- CMV remains a critical infectious agent in renal transplantation, necessitating careful management.
- Understanding donor/recipient CMV status is crucial for risk stratification and prevention strategies.
- Further research is needed to optimize prophylaxis and treatment protocols to reduce CMV-related complications in transplant recipients.