Comments on CMV infections in renal transplant patients.

Studies on 34 renal transplant's (in patients who received kidneys from living related donors) and 19 renal transplants (in patients who received kidneys from cadaver donors) have now been completed. Sixty-two percent of the living related kidney recipients became infected with cytomegalovirus (CMV) and 79% of the cadaver kidney recipients became infected. Of the group receiving kidneys from living related donors, 11 had an HLA identical match, and seven of these became infected, a fraction not significantly different from the overall percentage of infection in the living related recipients. The CMV antibody status of the kidney donor appears to be extremely important in determining whether the recipient manifests CMV infection or not. Table 1 relates the CMV complement fixation (CF) antibody status of the kidney donor to CMV infection in living related recipients. It can be seen that if the kidney comes from a CMV antibody-positive donor there is a signift lntly increased chance that the recipient will become infected (P < 0.02). Table 2 relates the antibody status of kidney donors to CMV infection in seronegative recipients. The same increased risk of infection if the kidney is from an antibody positive donor is noted (P < 0.005). Table 3 relates the antibody status of the kidney donor to CMV infection in all recipients. Once again the pattern of increased risk of infection if the kidney is received from an antibody-positive donor is evident (P < 0.005). This finding is striking and consistent. In an attempt to demonstrate virus in the donor kidneys, 19 kidney biopsies were cultured by growing the cells on glass or cocultivating with human embryonic lung fibroblasts in an attempt to recover virus. Eight of the kidney biopsies were from seronegative donors, six were from seropositive donors, and from five there was no blood available. No virus was cultured from the kidney biopsies. In five of the study patients and in three additional patients not in the study, we were able to clearly identify a particular type of response to CMV infection. Six weeks or longer after receiving the kidney, this group of patients developed fever, chills, leukopenia, and lymphocytosis usually accompanied by an increase in creatinine and a transient elevation of SGOT. All five of the study patients had no CMV CF antibody initially present, received kidneys from antibody positive donors, showed a fourfold or greater rise in antibody, and excreted virus in their urine. Four of the five had positive buffy-coat cultures, and four of the five were from the living related group. This clinical presentation was initially felt to be possible evidence of rejection, but