Objectives: To report clinical manifestations, laboratory findings, and treatment outcomes of in kidney transplant recipients who had cytomegalovirus (CMV) infections.
Methods: This retrospective study evaluated the records of kidney transplant recipients followed regularly from 2001 to 2006. In some patients information was also gathered through a telephone call or physical examination. The CMV infection diagnosis was also made by detecting PP.65 antigen per 50,000 peripheral blood leukocytes.
Results: Of the 200 kidney transplant recipients, 66 were infected with CMV including 42 men and 24 women. The mean patient age was 40 +/- 13 years (range, 14 to 67 years). Seventy-nine percent of the infected patients were diagnosed during the first 6-months after transplantation. All except 22 patients (33%) had constitutional complaints. Fever was present in 65% of patients, abdominal pain in 21%, diarrhea in 20%, and vomiting in 15%. Likewise, pulmonary complaints including cough and dyspnea were reported by 32% and 23%, respectively. However, 20% of patients were completely asymptomatic. Hematologic laboratory data showed anemia (64%), thrombocytopenia (47%), and leukopenia (21%). Seventy eight percent of patients had a serum creatinine <or=2 mg/dL before infection, but it was <or=2 in just 26% at the time CMV was diagnosed and 60% after treatment. Antiviral therapy included intravenous gancyclovir in 80% of patients and gancyclovir plus oral acyclovir in 20%. Corticosteroid pulse therapy was also administered in 78% of patients. No statistically significant correlation was observed between CMV antigen load and the severity of clinical manifestations or the time of response to treatment or the recurrence prognosis. In our series, 1 patient died, 28 treated patients (42%) experienced CMV recurrence, and 37 (56%) showed no recurrence.
Conclusions: CMV infection should be considered in any renal transplant recipient who has a rise in creatinine even if symptom-free. Despite the results of other studies, we found no prognostic value for the viral antigen load.