CLINICAL COURSE OF CYTOMEGALOVIRUS (CMV) VIREMIA WITH AND WITHOUT GANCICLOVIR TREATMENT IN CMV-SEROPOSITIVE KIDNEY-TRANSPLANT RECIPIENTS - LONGITUDINAL FOLLOW-UP OF CMV PP65 ANTIGENEMIA ASSAY

This study was designed to evaluate the longitudinal history of cytome galovirus (CMV) infection and to test the capacity of ganciclovir as e ffective therapy in CMV-seropositive renal transplant recipients. The CMV viremia was detected with CMV pp65 antigenemia assay in 153 renal transplants. The recipients were classified as having low-grade and hi gh-grade CMV infections according to the severity of CMV infection. Th e recipients with low-grade CMV infections were observed without ganci clovir treatment, and the recipients with high-grade CMV infection wer e randomly assigned to ganciclovir-treated and untreated groups. The c linical course between low-grade and high-grade CMV infections was eva luated. All recipients with low-grade CMV infection (n = 62) showed sp ontaneous remission regardless of immunosuppresants, In high-grade CMV infection (n = 31), the ciclosporin A treated group (n = 11) showed n o evidence of CMV disease, and the methylprednisolone-treated group (n = 8) showed CMV disease in 1 (25%) of 4 ganciclovir-untreated recipie nts. In the OKT3 group (n = 12), symptomatic CMV infection was observe d in 6 (100%) ganciclovir-untreated recipients contrary to no CMV dise ase in the ganciclovir-treated group (p < 0.05). In conclusion, the CM V antigenemia assay is effective in monitoring CMV viremia, and gancic lovir treatment should be done during early CMV viremia in OKT3-treate d recipients.