Abstract
Clinical features and pathogenetic factors of cytomegalovirus (CMV) infection were analyzed in 41 patients who underwent kidney transplantation at Kitasato University Hospital between December 1974 and June 1986. They were immunosuppressed with azathioprine (AZ) and prednisolone (PSL) (group I, 9 patients), AZ, PSL plus mizoribine (MZR; group II, 8 patients) or cyclosporine A (CYA), MZR and PSL (group III, 24 patients). Twenty donors were also studied for their serum anti-CMV antibodies. Serum antibodies were measured using the complement fixation method, and immunoglobulin class was determined by ELISA assay. Virus detection in the urine was performed by observing the characteristic cytopathic changes in cultured human embryonal fibroblasts caused by CMV infection. T-cell subsets of the peripheral blood were analyzed by flow cytometry using FITC-labeled anti-Leu3a and anti-Leu2a antibodies.
The incidence of CMV infection during the first six post-transplant months was found to be 70.7%, or 29 of 41 patients at risk, although most of them remained asymptomatic. The incidence was not significantly different among the three groups of patients under different immunosuppressive regimens (groups I, II and III). However, group III patients with CMV infection showed significantly decreased Leu3a+cells and Leu3a/Leu2a ratio compared with those in the same group without infection (p<0.025). Although no significant overall correlation was observed between rejection episodes and CMV infection, four patients showed an increase in serum creatinine levels following CMV infection. Recent infection was observed in two of 20 donors, and post-transplant anti-CMV antibody levels increased in both of the respective recipients. Accordingly, antibody-negative recipients should be allografted from antibody-negative donors in order to minimize infection in the kidneys.
