Early clinical manifestations and laboratory findings before and after treatment of cytomegalovirus infection in kidney transplant patients.

Cytomegalovirus (CMV) is one of the most frequently encountered opportunistic viral pathogens in kidney transplant recipients. In this study, we retrospectively reviewed all living related and unrelated kidney transplant recipients on regular follow-up from January 2006 to June 2015, who were suspected to have CMV clinically and confirmed by DNA polymerase chain reaction (PCR). CMV PCR was detected in 102 kidney transplant recipients. The median time of detection after kidney transplant was 21 months, ranging from 15 days to 84 months. There were 58 male and 44 female patients. The induction immunosuppression in living related kidney transplants was with antithymocyte globulin or basiliximab, whereas the most common maintenance immunosuppressive regimen was with cyclosporine, mycophenolate mofetil, and prednisolone. Most of the transplant recipients were asymptomatic at the time of detection of CMV PCR (67%). Fever, mainly low grade, was the main presentation in 16% of patients, followed by diarrhea (15%) and pneumonitis (2%). The most common hematological abnormality was lymphopenia seen in 46% of patients, followed by anemia (40%) and thrombocytopenia (14%). The common biochemical abnormalities found were elevated alanine aminotransaminase (18%) and hyperbilirubinemia (9%). The serum creatinine was found to be above baseline in 72% of patients. All patients with CMV infection were treated with intravenous ganciclovir, 2.5-5 mg/kg q 12 hourly, according to creatinine clearance, for 21 days. The treatment was successful in all but two patients, who died during the treatment period. There was a significant improvement in the kidney and liver functions after successful treatment of CMV infection. Our study shows that CMV infection should be considered in a patient presenting with unexplained rise in serum creatinine, low-grade fever, diarrhea, or anemia. A significant improvement in kidney and liver functions was observed after successful treatment of the infection.