RAPID DIAGNOSIS OF CYTOMEGALOVIRUS-INFECT ION IN RENAL-TRANSPLANTS

Cytomegalovirus (CMV) infection is one of the main causes of infectiou s morbidity and mortality in renal transplant (RT). The efficacy of an tiviral drugs in highly related their early implementation, so that th e availity of rapid diagnostic methods is important With the aim of de termining which are the most useful, we conducted a prospective study to compare several of these tests. From feb/87 to july/92, 174 renal t ransplants were prospectively studied for cytomegalovirus disease (CMV D) to infection (CMM). 23 patients who lost their grafts during the fi rst 3 post-transplant months were excluded of the analysis, remaining 151 patients for study (107 men and 44 woman, age 43 +/- 12, 12-68 yea rs). The virological protocol consisted in collecting peripheral blood leukocytes, urine and serum samples weekly during the first two post- transplant months and then in each clinical revision during the first year. Virological studies included conventional and shell-vial culture s in blood and urine, indirect immunofluorescence with monoclonal anti bodies in buffy coat(antigenemia), and detection of IgG and IgM antibo dies (FC and EIA assays). The analitical determinations were 13,475. C MVD was defined by the appearance of at least two tests with at least two of the following symptoms: fever, leukopenia, hepatitis, pneumonit is or intestinal damage without other etiology. 26 patients (17.2%) su ffered disease, and in 17 of them (65%) CMV was detected in buffy coat , urine and serum. Antigenemia was the first positive test detected an d seroconversion by FC assay the last one (42 +/- 19 vs 93 +/- 54 days post-transplant, p <0.007). It wes also the most sensitive (84.2%). I nfection was detected before or at the same time than clinical symptom s in 22 patients (85%), Antigenemia was also the test that more frecue ntly preceded the appearance of clinical symptoms (in 16 patients, 67% , 12 +/- 13.7 days, 0-55). In conclusion, the protocolized screening o f renal transplant patients afford us to diagnose cytomegalovirus infe ction before the appearance of clinical symptoms in the mayority of pa tients. This allows faster implementation of therapeutic or prophylact ic measures. In our study, antigenemia proved to be the most useful te st.