Cytomegalo virus (CMV) is the most common viral infection after kidney transplantation, with an overall frequency of 50-80%, and 30-60% for CMV disease. We retrospectively analyzed medical records of 689 kidney transplant recipients at Jeddah Kidney Centre (JKC) from January 2000 till December 2005 for CMV infection and disease, and its effect on graft & patients' survival.Out of 689 kidney transplant recipients, 25 patients (3.6%) had acute CMV disease. We looked at the source of kidneys, CMV sero-status of both donor and recipient, immunosuppressives, CMV prophylaxis, clinical presentation of acute CMV disease, response to treatment and effect of CMV disease on both graft and patient survival. All the 25 patients had CMV IgG positive /IgM negative test before transplantation.
We noticed two distinct groups of patients. The first group included 9 patients diagnosed to have CMV syndrome, 6 of which received CMV prophylaxis in the form of gancyclovir. All patients in this group had CMV low PCR viral load, mild disease, and responded to treatment with complete recovery and no adverse effect on graft or patients. The second group included 16 patients diagnosed to have CMV invasive disease, 3 of which received CMV prophylaxis. All patients in this group were found to have very high CMV PCR viral load. Thirteen patient (81%) in this group responded to treatment with full recovery maintaining normal graft function in 10 patients (62%), while 3 patients (18.8%) survived the CMV invasive disease but lost their graft retuned back to dialysis. Three patients (18.8%) died from CMV disease & related complications. We report a low incidence of CMV disease, 3.6%, in our centre. CMV prophylaxis was associated with milder form of the disease. Treatment of CMV invasive disease offered 81% patient survival and 62% graft survival in our centre.