Cytomegalovirus infections in transplant patients

Cytomegalovirus (CMV) infections are a major problem in transplant recipients, although recent advances in diagnosis, prevention and therapy have reduced the risk of CMV disease. To illustrate these advances, the risks of CMV disease and subsequent death were analyzed in 482 consecutive bone marrow transplant (BMT) patients transplanted between 1975 and 1994. No CMV-seronegative patient with seronegative donor marrow developed disease. Among the remaining 384 patients, the risk for CMV disease was reduced from 13.0% in patients transplanted between 1975 and 1985 to 2.2% in those transplanted between 1991 and 1994 (p = 0.06). The corresponding risks for death due to CMV disease were reduced from 13.0% to 0% (p = 0.002). Significant factors in multivariate analysis for the reduction of death from CMV disease were acute graft-versus-host disease and pre-emptive therapy based on rapid diagnosis with polymerase chain reaction. These data are discussed in relation to previously published results in BMT and solid organ transplant patients.