DIAGNOSTIC MARKERS AND RISK-FACTORS OF CYTOMEGALOVIRUS-INFECTION AND DISEASE IN RENAL-ALLOGRAFT RECIPIENTS

In a prospective study, the incidences of CMV infection and disease we re 56 and 23%, respectively, during the first 6 months following kidne y transplantation. Viremia was found in all patients with CMV disease and arthralgia was present in 71% prior to the development of CMV dise ase. The positive predictive value for CMV disease reached up to 90% f or viremia and arthralgia in combination. Viruria was poorly correlate d to viremia and hence CMV disease, The majority of patients (93%) who developed CMV disease had a seropositive donor, and viremia was signi ficantly more common in patients who received CMV-seropositive kidneys , CMV disease was more common in CMV-seronegative recipients than in s eropositive recipients. The 1-year graft survival rate was 75% in the entire study group. In patients with CMV viremia and disease, the surv ival rates were 61 and 60%, respectively. The patient survival rate 1 year after transplantation was 91% in the entire study group, In patie nts with CMV viremia and CMV disease the rates were 78 and 73%, respec tively, Antiviral treatment was initiated within 3 weeks of viremia de tection in the 6 patients with CMV disease who survived, We found that the combination of arthralgia and viremia was a useful predictor of C MV disease and that recipients of CMV-seropositive allografts were at a greater risk of developing CMV disease, To obtain an early diagnosis and commence an early treatment of CMV disease, patients prone to dev elop CMV disease should be identified and clinical examination and vir emia surveillance should be performed regularly