Dr Ho and I are in agreement that CMV is a major pathogen after renal transplantation. We also agree that distinguishing between primary CMV and reactivation infection in renal allograft recipients is extremely important in defining the epidemiology of CMV and devising strategies for disease control. We seem to disagree on his emphasis of the importance of primary infection. I do not contend that primary CMV infections in renal allograft patients are benign—quite the contrary is often the case. However, my precise point, as quoted from my editorial, is "that reactivation infections can be as virulent as primary ones." I want to underscore that reactivation infection (that is, CMV infection in an allograft recipient who is seropositive to CMV prior to transplant) can be severe and even lethal.
A prospective study to be published shortly provides some details of the morbidity of CMV disease in our transplant patients.1