Polyvalent immune globulin and cytomegalovirus infection after renal transplantation

To determine whether polyvalent, immune globulin (IgG) prevents cytomegalovirus (CMV) infection after cadaver renal transplantation, 28 patients were randomly allocated to receive 12 weekly infusions of 500 mg/kg of IgG (n=15) or no treatment (n=13). Both groups were similar with respect to age, sex, antigen mismatches, number of diabetics, and pretransplant donor/recipient CMV antibody titers. Moderately severe CMV infections occurred in 10 (77%) of 13 control subjects compared with 8 (53%) of 15 IgG-treated patients (not significant). Among those who developed CMV infections, prophylactic IgG had no effect on the severity or duration of fever, leukopenia, or hepatic enzyme elevations. Since none of the IgG-treated patients or control subjects in this study developed life-threatening CMV complications, a beneficial effect of prophylactic IgG in the small number of patients at risk for more severe CMV infections could not be excluded. However, this investigation suggests that the routine, prophylactic administration of polyvalent IgG, to prevent or to ameliorate CMV infection in unselected cadaver renal transplant recipients, is not warranted.