[Cytomegalovirus infections following kidney transplantation - clinical and serological studies of the early and late phases].

In 71 patients after kidney transplantation the cytomegalovirus-antibody state was recognized with the help of the indirect fluorescence antibody test in a period of 24 months. The first estimations were performed in 33 patients in the early phase up to the 3rd month and in 38 patients in the late phase up to the 100th months after transplantation. Of 13 patients who had been controlled already before operation only 3 patients were seronegative. After this twice a seroconversion with clinically manifest cytomegalovirus infection appeared, in one case an irreversible failure of the graft developed. In the late phase 4 patients remained seronegative. Of these patients also in one case the chronic rejection caused the entering into the dialysis programme. -- A positive cytomegalovirus-antibody state was found in the early phase in 30 of 33 patients and in the late phase in 34 of 38 patients. An active cytomegalovirus infection was present in the early phase in 11 of 30 and in the late phase in 11 of 34 patients. In the early phase the clinical symptoms fever, leukopenia and hepatitis were more frequent and more expressed than in the late phase. In 7 of the 11 patients in the early phase and in 8 of 11 patients with active cytomegalovirus infection in the late phase rejections occurred which in 2 of the 7 patients in the early phase and in 5 of the 8 patients in the late phase led to the loss of the graft. In inactive cytomegalovirus infection an irreversible course thrice appeared in 11 patients with rejections. Three typical instances are demonstrated: 1. The course of an active cytomegalovirus infection in the early phase with rejection and irreversible failure of the graft. 2. The reactivation of a latent cytomegalovirus infection by uncontrollable rejection processes. 3. The course of an active cytomegalovirus infection without clinical complications and with transition into an inactive stage in minimal immunosuppression. The treatment is performed with immunosuppression of a possibly low dosage, the avoidance of increases of prednisolone in cytomegalovirus-associated rejections, the intravenous application of human-gamma-globulin as well as the prevention or intensive treatment of superinfections. In these cases the close relations between rejection processes, immunosuppressive therapy, superinfections and cytomegalovirus infections should find the necessary consideration.