Cytomegalovirus infection and renal transplantation

Cytomegalovirus (CMV) infections remain a major clinical problem after renal transplantation. Reported incidences of CMV disease range from 17 to 25% in patients with azathioprine treatment and from 2 to 23% in patients on cyclosporin A. CMV-related death occurs in 1-3% of the total kidney transplant population. CMV seronegative kidney recipients of a transplant from a seropositive donor are especially at risk for primary infection as CMV can be transmitted by the transplant. In patients treated with antilymphocyte globulin (ALG) preparations for rejection, CMV disease is diagnosed three to four times more frequent than in patients without ALG therapy. Prevention of CMV infection is possible by selecting CMV seronegative donors for seronegative recipients. Active and passive immunization does not prevent CMV infection after renal transplantation, but immunoprophylaxis may result in less severe CMV disease. Effective treatment of clinical overt CMV disease is possible with the new guanine analogue ganciclovir. However, the use of this drug is associated with neutropenia, especially in patients with compromised kidney function. More pharmacokinetic data are needed to determine optimal dosing schemes.