RISK-FACTORS FOR CYTOMEGALOVIRUS-INFECTION AND DISEASE IN RENAL-TRANSPLANT RECIPIENTS - HLA-DR7 AND TRIPLE THERAPY

In a prospective study, an analysis of risk factors for the developmen t of cytomegalovirus (CMV) infection and disease was performed on 77 r enal allograft recipients. Twenty-five out of the 77 recipients (32%) had a CMV infection. Twenty-two of the recipients received triple immu nosuppressive therapy (cyclosporin A, prednisolone, and azathioprine) while the remaining 55 received standard therapy (cyclosporin A and pr ednisolone). In 23 recipients (30%) acute rejection was diagnosed and the first positive parameter of infection occurred 22 days after rejec tion therapy. Infection occurred in 10 out of 18 HLA-DR7-positive reci pients (56%) and in 15 out of 59 HLA-DR7-negative recipients (25%; P < 0.02). In multiple regression analysis, HLA-DR7 was found to be a sig nificant predictor of CMV infection (P < 0.005). CMV disease was diagn osed in only 9 out of 25 recipients with an acute infection. Six recip ients (67%) with CMV disease received triple therapy for maintenance i mmunosuppression; this was significantly correlated to CMV disease (P < 0.05) as compared to three recipients (33%) with CMV disease maintai ned with standard therapy. Our data suggest that HLA-DR7-positive reci pients are more susceptible to CMV infection and that CMV disease is a ssociated with triple immunosuppressive therapy.