CLINICAL COURSE OF CYTOMEGALOVIRUS (CMV) VIREMIA WITH AND WITHOUT GANCICLOVIR TREATMENT IN CMV-SEROPOSITIVE RENAL TRANSPLANT RECIPIENTS: LONGITUDINAL STUDY OF CMV PP65 ANTIGENEMIA ASSAY

Abstract

600 This study was designed to evaluate the longitudinal history of cytomegalovirus (CMV) infection and to test the capacity of ganciclovir as effective therapy in CMV-seropositive renal transplant recipients. The CMV viremia was detected with CMV pp 65 antigenemia assay in 153 renal transplants. The recipients were classified as having low-grade (1-10 /50,000 PBMC) and high-grade CMV infections (> 10/50,000 PBMC) according to the severity of CMV infection. The recipients with low-grade CMV infections were observed without ganciclovir treatment, and the recipients with high-grade CMV infection were randomly assigned to ganciclovir-treated and untreated groups. The clinical course between low-grade and high-grade infections was evaluated. All recipients with low-grade CMV infection (n=62) showed spontaneous remission regardless of immunosuppressants. In high-grade CMV infection (n=31), the cyclosporine-treated group (n=11) showed no evidence of CMV disease, and the methylprednisolone-treated group (n=8) showed CMV disease in 1 (25%) of 4 ganciclovir-untreated recipients. In the OKT3 group(n=12), symptomatic CMV infection was observed in 6 (100%) ganciclovir-untreated group contrary to no CMV disease in ganciclovir-treated group (P<0.05). In conclusion, CMV-seropositive recipients receiving CsA and/or steroids alone do not have an important clinical problem with CMV infection. This group does not need to receive prophyaxis and can be followed by CMV antigenemia study. But OKT3-treated recipients should receive ganciclovir during early CMV viremia to prevent significant clinical consequences.