Clinical manifestation, laboratory findings, and the response of treatment in kidney transplant recipients with CMV infection

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 ≤2 mg/dL before infection, but it was ≤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.