CMV INFECTION IS ASSOCIATED WITH TRANSPLANT RENAL-ARTERY STENOSIS

Transplant renal artery stenosis (TRAS) is a significant cause of graf t dysfunction, with no clearly defined aetiology. Evidence suggests a Pole for cytomegalovirus (CMV) infection in cardiac transplant vasculo pathy and in native coronary artery restenosis after angioplasty. We i nvestigated the relationship between CMV infection after renal transpl antation and subsequent development of TRAS. Of 917 patients receiving renal transplants at a single centre from 1978 to 1994, 75 had TRAS d iagnosed by angiography. Each was paired with a control transplanted p atient with no TRAS, matched for age, sex, year of transplant and numb er of grafts. Incidence of CMV infection between transplantation and t he time of diagnosis of TRAS was assessed in both groups, using clinic al and serological criteria to assign patients to three groups: defini te CMV infection (CMV-DEF), possible infection (CMV-POSS) and no evide nce of infection (CMV-NUL). CMV-DEF was significantly more common in T RAS than in controls (36 vs. 12, respectively, p<0.001) and CMV-NUL wa s less common (TRAS 15, controls 33). We have previously reported an i ncreased incidence of acute rejection in patients with TRAS. The subse t of patients with no rejection episodes also had significantly more C MV-DEF cases in the TRAS group (54%) than in controls (10%) (p=0.002), The data are consistent with the hypothesis that CMV infection can co ntribute to the development of TRAS. The relationship between CMV and TRAS did not arise from an excess of anti-rejection treatment in the T RAS group. CMV-induced large-vessel damage in immunosuppressed patient s may occur through local infection and the mitogenic actions of viral gene products within cells of the vessel wall.