[Cytomegalovirus diseases following allogenic kidney transplantation]

Lymphotrophic virus infections, especially when they are caused by the cytomegalovirus, are severe complications after allogenic organ transplantation. First infections are mainly caused by donation of CMV-positive organs to CMV negative recipients. The regular incubation time of 30 to 40 days can be significantly shorter after therapeutic application with high dose prednisone or mono/polyclonal antibodies for treatment of rejection. The spectrum of clinical signs of the CMV-disease after organ transplantation can range between serological alterations and the lethal CMV-syndrome. The early recognition of virus-dependent clinical symptoms and the establishment of the diagnosis are the first conditions for the treatment, consisting in reduction of the immunosuppressive medication and application of ganciclovir, a CMV-specific virusstatic agent. The prophylactic application of CMV-hyperimmunoglobulin is discussed controversially. A very important aspect of CMV-disease in the long-term follow-up is the influence of this virus infection on the development of chronic organ rejection, which could be demonstrated in animal studies by application of the Marek virus and which was seen in pathomorphological samples of transplant biopsies. Future diagnostic and therapeutic strategies, which aim at the prolongation of the patient's survival and the transplant function have to consider the influence of virus infections as a severe risk-factor, as the transplantation of CMV-negative organs to CMV-negative recipients is more the exception than the rule.