Cytomegalovirus-related disease is a risk factor of acute rejection in renal transplant recipients: A case-controlled study

OBJECTIVES: We studied the relationship between cytomegalovirus infection a nd episodes of acute rejection after infection in renal graft recipients at the Reims University Hospital from 1989 to 1995. PATIENTS AND METHODS: Two exposed versus nonexposed analyses were conducted , one (series 1) for CMV infection and the other (series2) for CMV disease. For each analysis, exposed recipients were matched with nonexposed recipie nts for date of graft (+/- 6 months). Risk of acute rejection was assessed with univariate analysis then with multivariate analysis using logistic reg ression. RESULTS: Among the 192 graft recipients included, 64 developed CMV infectio n, 77 had an infection (series 1)and 51 had CMV disease (series 2). in seri es 1, only failure of renal graft was a significant risk factor of acute re jection (OR=10.4; 95% CI 1.9 - 56.3). CMV infection was not a significant r isk factor (OR = 1.06; 95% CI 0.2 - 5.6). Conversely, in series 2, there wa s a 6-fold increase in the risk of acute rejection in recipients who develo ped CMV disease (OR = 5.98; 95% Ci 1.21 - 29.4). CONCLUSION: The fact that CMV disease and not CMV infection is a risk facto r of acute rejection in renal transplant recipients is an argument for impl icating a general inflammatory reaction characteristic of CMV disease in th e pathogenesis of acute rejection. This finding favors preventive treatment of CMV infection. (C) 1999, Masson, Paris.