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Cytomegalovirus disease among renal transplant recipients in India

SUMMARY: There is a paucity of data on cytomegalovirus (CMV) disease in renal transplant recipients from India. We have encountered this problem with increasing frequency at our centre, and document our experience in this paper. Case records of 514 recipients of renal transplants performed between 1980 and 1997, including 96 autopsies, were reviewed. Diagnosis was made by demonstration of classic cytomegaly and intranuclear inclusions on histology, and/or detection of CMV pp‐65 antigen in the peripheral blood leucocytes. Cytomegalovirus disease was documented in 21 cases (11 at autopsy, six by antigen detection, and four by a combination of histological demonstration and antigenemia detection). the incidence of this infection rose from 0.6% in 1980–1991 (pre‐cyclosporin era) to 5.5% (4.4% lethal) during 1992–1997 (postcyclosporin era). At autopsy, the lung was the most frequently involved organ followed by the gastrointestinal tract. Ninety‐five per cent of patients had co‐infection with other organisms, and fungi were isolated in 80% of all patients with co‐infection. Graft dysfunction was present in 17 cases (81%). We conclude that there has been a four fold increase in the incidence of lethal CMV disease in renal transplant recipients after the introduction of cyclosporin immunosuppression. There is a high incidence of co‐infection with other organisms, with fungi being the commonest offenders in tropical environment. This, along with allograft dysfunction, could account for the high mortality seen with CMV disease.