Influence of anti-rejection therapy on the timing of cytomegalovirus disease and other infections in renal transplant recipients

Infections are an important cause of mortality and morbidity in renal trans plant recipients. To study the impact of anti-rejection therapy on the timi ng of infections, the records of 599 consecutive renal transplants, perform ed prior to 31 December 1996 at the Royal Melbourne Hospital, were reviewed . Patients were grouped according to acute rejection (AR) episode and treat ment during the first 6 months after transplantation. Group 1 [n = 168 (35% )] patients did not experience any episode of AR. Group 2 [n = 169 (35%)] p atients had one or more episodes of AR and received high doses of steroids. Group 3 [n = 141 (300/0)] patients had more than one episode of AR and rec eived anti-lymphocyte antibodies in addition to high doses of steroids. Inf ections were more common in Groups 2 and 3 but only cytomegalovirus (CMV) d isease occurred earlier in patients treated with lympholytics. Given the hi gh incidence and early onset of CMV disease in patients receiving lympholyt ics and considering that an effective prophylactic protocol remains undeter mined, pre-emptive treatment with ganciclovir in this high risk group appea rs justified.