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Cytomegalovirus The Troll of Transplantation

Henry H. Balfour Jr, MD
Arch Intern Med. 1979;139(3):279-280. doi:10.1001/archinte.1979.03630400011006.
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Cytomegalovirus (CMV) is the most common recognized pathogen in the first six months after renal transplantation.1-4 Although once considered a commensal organism, evidence is now overwhelming that CMV is a major cause of posttransplant fever and leukopenia in renal allograft recipients, and is often responsible for pneumonitis, hepatitis, retinitis, encephalitis, and even death.5 Cytomegalovirus infections complicate bone marrow6 and cardiac transplantatin7 as well.

Specific treatment of posttransplant CMV infection is still not possible. Vidarabine (adenine arabinoside), which appears therapeutic for certain herpes group infections, has been ineffective for treatment of CMV in renal allograft recipients. In addition, the drug may have CNS toxicity in patients with impaired renal function.8 The best we can do at present is to document CMV infection and then decrease immunosuppression to permit the host to combat the virus himself. In so doing, we risk loss of the allograft. Clinical suspicion


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