[Primary cytomegalovirus infection as a risk factor following kidney transplantation]

Of 201 patients who received cadaver kidneys in the kidney transplant centre in Berlin between June 1978 and December 1981 114 (56.7%) already had complement-binding antibodies against cytomegaloviruses (CMV) before transplantation, 87 (43.3% were seronegative. After transplantation a recurring CMV infection was detected in 36/114 patients and a primary CMV infection in 27/87 patients (31.6% and 31.0% respectively). At dismissal from ward care these patients already had a significantly higher rate of transplant failure than those free of CMV infection. This negative effect of the infection was reinforced by the additional administration of a Prednisolone bolus for the treatment of the rejection crisis associated with CMV. At the same time immunological protection was further suppressed. Thus, in comparison with patients with primary CMV infection not treated with Prednisolone bolus, those with primary CMV infection and parallel treatment with a Prednisolone bolus had a higher rate of T-lymphocytopenia and a significantly delayed humoral immune response to CMV. Together with the usually present leukocytopenia, these findings explain the especially high risk of potentially fatal superinfections in this period. Diagnosis of CMV infection on the basis of clinical symptoms and haematological changes must be speedy. A therapy which is effective with regard to life (although symptomatic) comprises the temporary reduction of the azathioprine dose, the administration of antibiotics and the infusion of human gamma-globulin. It might be possible to avoid primary CMV infection, which presents a particularly great risk, by vaccination of the potential transplant recipient.