Cytomegalovirus Infection and Disease Following Renal Transplantation: Preliminary Report of Incidence and Potential Risk Factors
Background. Cytomegalovirus (CMV) infection and disease are major causes of morbidity and mortality after renal transplantation. However, the incidence and potential risk factors are different in developing countries. We sought to determine the incidence and potential risk factors for CMV infection and disease in our center. We also sought to identify groups of recipients who may benefit from preemptive therapy. Materials and methods. Forty renal transplant recipients were monitored regularly for CMV infection within 6 months after transplantation using CMV immunoglobulin (Ig) M and IgG titers, pp65 antigenemia, and CMV DNA by polymerase chain reaction (PCR). Thorough laboratory and physical examinations were performed to detect CMV disease. We evaluated the role of various factors in CMV infection and disease development using Cox regression and Kaplan-Meier statistical models. Results. CMV infection and disease were detected in 33 (82.5%) and 10 (25%) subjects, respectively. Average time to infection and disease development was 4.7 and 11 weeks, respectively. PCR was the most accurate method of diagnosis in 22 (67%) cases. By comparison to other recipients, patients who received antithymocyte globulin (ATG) showed a significant decrease in time to disease development (P = .009). Upon multivariate survival analysis, ATG therapy remained an independent risk factor for CMV disease (odds ratio: 6.8; P = .02). Conclusion. Due to the low rate of progression from CMV infection to disease, it does not seem reasonable to perform preemptive therapy in all infected cases. ATG therapy was an independent risk factor for CMV disease. Recipients of this treatment would be proper candidates to receive preemptive therapy.