Clinical characteristics of the lethal cytomegalovirus infection following renal transplantation

An ongoing prospective study of the role of viruses in renal transplant recipients has provided identification of two patterns of cytomegalovirus (CMV) infection. In both patterns, fever and leukopenia occur within 6 months after transplant. In addition, the benign form is characterized by renal biopsy evidence of rejection and brisk antibody responses to CMV. The lethal syndrome runs a typical 4-week course, beginning with prostration, orthostatic hypotension, and mild hypoxemia, and progressing to severe pulmonary and hepatic dysfunction, muscle wasting, central nervous system depression, and death. Antibody responses to CMV are minimal, and renal biopsy does not show rejection despite elevation of serum creatinine. At autopsy, CMV is found in lung, liver, kidney, gastrointestinal tract, and brain. Successful management of the potentially lethal CMV syndrome requires rapid clinical recognition and immediate reduction of immunosuppressive therapy. Future prospects for control include development of a CMV vaccine and specific antiviral chemotherapy.