THE ROLE OF PRETRANSPLANT IMMUNITY IN PROTECTION FROM CYTOMEGALOVIRUS DISEASE FOLLOWING RENAL TRANSPLANTATION

Abstract

To determine the extent to which pretransplant immunity resulting from natural infection protects against cytomegalovirus (CMV) disease, we analyzed CMV serology on 153 kidney donor and recipient pairs and followed transplant patients to determine incidence and severity of CMV disease. The overall incidence of CMV disease was 22%. Significant differences occurred in CMV disease incidence and severity, depending on the immune status of the kidney donor and recipient. Among recipients of kidneys from seropositive donors, immunity offered significant protection from CMV disease, reducing its incidence from 61% in nonimmune to 24% in immune patients (P<0.01). Pretransplant immune patients also had fewer CMV-related complications. Among recipients of kidneys from seronegative donors, pretransplant immunity conferred a significant risk of CMV disease; immune patients had a 20% incidence of CMV disease compared with 2% in nonimmune patients (P<0.02). Disease was generally mild in all patients receiving kidneys from CMV-seronegative donors. Patients experiencing a primary CMV infection had a 3-fold higher incidence of CMV disease than patients with reactivation infection (P<0.01). The incidence of CMV disease was similar in immune patients, whether they