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The problem of cytomegalovirus infection in renal allograft recipients
Abstract:
A prospective study of the effects of cytomegalovirus (CMV) infection on 145 recipients of 155 renal allografts is reported. Immunosuppression was either with azathioprine and low-dose prednisolone (103 transplants) or with Cyclosporin A (52 transplants). Sixty-one cases of CMV infection were diagnosed; of those 21 were primary (i.e. in CMV sero-negative recipients) and 40 were secondary (i.e. in previously sero-positive recipients). The infection rate in patients treated with azathioprine and low-dose prednisolone did not differ from the rate in those treated with Cyclosporin A. Eighteen of the 21 primary CMV infections were clinically overt; several of these patients became seriously ill, and one of them died. Only four of the 40 secondary infections were overt, and these were all mild. Graft and patient survival were not adversely affected by CMV infection. Indeed the group with secondary CMV had significantly better survival rates than the uninfected sero-positive or sero-negative patient groups. Recommendations to minimise the effects of primary CMV infections are given.
Insights
Cytomegalovirus (CMV) infection in kidney transplant recipients did not affect graft or patient survival. Primary CMV infections were severe, while secondary infections were mild, with improved survival in the latter group.
Area of Science:
- Nephrology
- Transplantation Immunology
- Infectious Diseases
Background:
- Cytomegalovirus (CMV) is a common opportunistic infection post-renal transplantation.
- Immunosuppression regimens, including azathioprine/prednisolone and Cyclosporin A, influence infection risk.
- Understanding CMV infection's impact on renal allograft recipients is crucial for patient management.
Purpose of the Study:
- To investigate the effects of primary and secondary cytomegalovirus (CMV) infections on renal allograft recipients.
- To compare CMV infection rates between different immunosuppression protocols.
- To assess the impact of CMV infection on graft and patient survival.
Main Methods:
- Prospective study of 145 renal allograft recipients (155 transplants).
- Patients received immunosuppression with azathioprine/prednisolone or Cyclosporin A.
- Diagnosis of CMV infection based on clinical presentation and serological status.
Main Results:
- 61 CMV infections diagnosed: 21 primary and 40 secondary.
- CMV infection rates were similar between azathioprine/prednisolone and Cyclosporin A groups.
- Primary CMV infections were often severe (18/21 overt), with one fatality.
- Secondary CMV infections were mostly mild (4/40 overt).
- Graft and patient survival were not negatively impacted by CMV infection.
- Secondary CMV infection was associated with significantly better survival rates compared to uninfected groups.
Conclusions:
- Primary CMV infections pose a significant risk of severe illness in renal transplant recipients.
- Secondary CMV infections are generally mild and may be associated with improved long-term outcomes.
- Strategies to mitigate primary CMV infection effects are recommended.