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Incidence of cytomegalovirus-infection after renal transplantation and first experiences with prophylactic hyperimmunoglobulin.

Incidence and clinical symptomatology of CMV-infection was investigated in 83 patients, who received cadaveric renal transplants in 1982 and 1983. CMV-antibody status was determined using an ELISA-technique, 43 of the 83 patients (52%) were seronegative, and 40 (48%) were seropositive for CMV before transplantation. Seroconversion (i.e. primary CMV-infection) or an increase in titre (i.e. reactivation or reinfection) was found in 18 cases (42% and 45%, respectively) in both groups. 89% of all infections occurred within the first 3 months. Clinical symptomatology was much more severe in the group with primary CMV-infection; all cases with atypical pneumonia (n = 8) and both fatal cases belonged to this group. Preformed CMV-antibodies thus appeared to prevent severe syndromes associated with CMV-infection. Therefore a randomized controlled study was started in 1984 in order to investigate the efficacy of an i.v. applicable CMV-hyperimmunoglobulin passively administered prior to the transplant procedure. The passive immunization was not capable of preventing CMV-infection in every case: 2 (late) seroconversions did occur, but in both cases subclinical infections were diagnosed, whereas in the control group CMV-infections were regularly associated with typical clinical complications (prolonged fever, liver damage, leucopenia etc.). Thus prophylactic CMV-hyperimmunoglobulin seems to be capable of preventing the occurrence of severe CMV-syndromes post transplantation. The study is being continued.