[Cytomegalovirus infection in patients after kidney transplantation]

Cytomegalovirus disease (CMV) (active infection with various clinical and laboratory symptoms) in patients after renal transplantation (Tx) is an important diagnostic and therapeutic problem. Early CMV antigen pp65 is a structural protein of the antigenic type. It was discovered as a marker of activation of CMV infection. We decided to test the value of the method of early CMV antigen detection in the diagnosis of CMV disease in patients after renal transplantation (Tx).

During a 10-month period 53 patients after Tx of the kidney were examined for the presence of early CMV antigen. Thirty-nine patients were followed up systematically, examined for the first time before Tx and then after regular one-week intervals. All patients were subjected to serological examination before Tx for the presence of antibodies against CMV, class IgG; in 41 during subsequent examinations also IgM antibodies were assessed. A method for the assessment of early CMV antigen was elaborated by cultivation of biological material in a tissue culture using monoclonal antibodies and indirect immunofluorescence. In the mentioned 53 patients a total of 363 examinations were made, mainly in blood and urine, 63 samples were positive Among the 39 patients followed up systematically early antigen was positive in 17 patients (44%). In three already before Tx. Positivity of the early antigen was first revealed on average 16 days (+/-4.2) after Tx and persisted on average for 13 days (+/-6.4). Positive early antigen was associated in the majority of patients with one or several clinical and laboratory symptoms, most frequently elevated body temperature. Comparison of early antigen and IgM anti-CMV were statistically evaluated by the chi sq. test, Fisher's test in contingency tables and by Student's non-parametric t-test.

We assembled new experience with the method of detection of early CMV antigen in the diagnosis of activation of CMV infection. The correlation of the method with clinical and laboratory symptoms, incl. anti-CMV IGM antibodies, was statistically significant. By this method it is possible to detect CMV activation on average already on the 16th day after Tx which contributes in a significant way to the early diagnosis of the disease and facilitates the differential diagnosis of conditions during the early postoperative period.