PRESENCE OF CYTOMEGALOVIRUS GENOME AND LEUKOCYTE SUBSETS IN RENAL-TRANSPLANT BIOPSIES - RELATIONSHIP WITH PROGNOSIS

The influence of immunosuppressant therapy and of the presence of CM V genome on the distribution of lymphoid subpopulations of the inflamma tory infiltrate in renal graft rejection was analyzed, as was the role of both factors in the evolution and survival of the graft. The study included 22 patients treated with Cyclosporin A (CsA) and 22 patients treated with Azathioprine (AZA). Inflammatory infiltrate was studied by immunostaining with a panel of monoclonal antibodies, and CMV DNA w as detected by in situ hybridization on tissue sections. In patients t reated with CsA, increased cellularity was found at both glomerular an d interstitial levels, consisting mainly of macrophages and T-cells, w hich was consistent with the higher rate of glomerulointerstitial reje ction found in this group. In contrast, the vascular type of rejection predominated in AZA treated patients. However, the presence of CMV DN A did not influence the phenotype of the inflammatory infiltrate, and was not associated with any specific lesion. Furthermore, the final ou tcome of the renal graft was independent of the detection of CMV. Ther efore, this study provides no evidence of any active role of the CM V genome in renal graft rejection, and suggests that therapy should be a dapted to the type of rejection as defined on morphologic and immunoph enotypic grounds.