Sixty-one immunosuppressed renal transplant recipients were systematically screened for virus infections and the findings correlated with their clinical course. Only herpesvirus (cytomegalovirus, herpes simplex and herpes zoster) were consistently isolated. The onset of virus infections could usually be associated with clinical syndromes. Patients without virus infections were usually asymptomatic. The clinical syndrome associated with virus infection consisted of fever, leukopenia and renal allograft rejection. Renal biopsy, performed at the time serum creatinine levels were elevated, revealed classic rejection; most rejections were reversed by increasing the dose of steroids. Patients continued to excrete virus even after antibody response and clinical recovery. Virus infections do not appear to be incidental findings in transplant patients except after recovery when the virus persists in the immune patient. The clear-cut association between virus infection and rejection episodes suggests a pathogenic relationship. The two mechanisms which seem to best explain the relationship are (1) the virus infection acting as an adjuvant and triggering the rejection of the allograft or (2) the allograft rejection activating a latent virus infection.
Bibliographical noteFunding Information:
From the Departments of Pathology, Surgery and Pediatrics, University of Minnesota, Minneapolis, Minnesota 55455. This work was supported by Grant No. AM 13083, Al-00798 and Al-08677 from the U.S. Public Health Service, Contract NCI 71-2261 from the National Cancer Institute, the National Foundation-March of Dimes, and the John A. Hartford Foundation. Requests for reprints should be addressed to Dr. Richard L. Simmons, Box 185 Mayo, University of Minnesota Hospitals, Minneapolis, Minnesota 55455. Manuscript accepted August 15, 1973. * Present address: Memorial Sloan-Kettering Cancer Center, 410 East 68th Street, New York, New York 10021. t John and Mary R. Markle Scholars in Academic Medicine.