CYTOMEGALOVIRUS-INFECTION IN RENAL-TRANSPLANT PATIENTS - SIGNIFICANCE OF SEROLOGY AND VIRAL CULTURE

We studied the incidence of cytomegalovirus infection and disease in a population of 60 consecutive renal transplant patients, by means of the periodic investigation of urine samples for the cytomegalovirus, with standard tube and << shell vial >> cell culture techniques, and serologic response, by Elisa. We also studied the possible association between the sequence of these two infection markers and the development of cytomegalovirus disease. Cytomegalovirus infection was diagnosed in 45 patients (75%): primary infection in four cases and secondary infection in the rest. Viral urine shedding was detected in 41 patients and serologic response of IgM class in 31. In 27 cases both markers were present. Three out of four patients with primary infection and 9 out of 41 patients with secondary infection developed cytomegalovirus disease. In patients with symptomatic infection, viral shedding began earlier in the postrasplant, and symptoms appeared within a period of 15 days since its detection. Cytomegalovirus disease was not more frequent when viral urine shedding persisted longer than one month. IgM CMV antibodies were present more frequently when viral shedding was protracted and it did not correlate with the appearance of disease. Given that viral shedding from urine precedes cytomegalovirus disease for a short period, surveillance of urine cultures with the << shell vial >> procedure, can be a useful method for monitoring patients during the first months postrasplant or after the use of antilymphocytic preparations. The maximum risk of developing cytomegalovirus disease could be during the first two weeks of viral shedding, since after this period, the risk is reduced, in spite of persistent viral shedding.