In addition, quantitation of CMV IgG and IgM was performed with an automated immunofluorescent check also

In addition, quantitation of CMV IgG and IgM was performed with an automated immunofluorescent check also. Asymptomatic CMV infection (ACI) was thought as antibody seroconversion not due to globulin infusion, and/or viral shedding, and/or positive early antigen detection or positive culture. allograft transplants on the School of Pittsburgh INFIRMARY (UPMC) between June 1, 1989, and could l, 1993, 116 (14.60%) R-D+ sufferers were retrospectively evaluated. Within this 47-month period, two different protocols for prophylaxis against CMV had been followed; through the first KT182 17 a few months. 43 sufferers received high-dose ACV by itself (group 1); through the pursuing 30 a few months, 73 sufferers received high-dose ACV in conjunction with CMV-Ig (group 2). Acyclovir medication dosage was calculated following guidelines recommended by Balfour et al5and altered if required with the scientific situation. The CMV-Ig mixture was implemented based on the dosage and schedule suggested by Snydman.4 Clinical characteristics of the patients are summarized inTable 1. Both groups were comparable for age, sex, graft source (living, related/cadaver), number of retransplantations, number of KT182 highly sensitized recipients, and adult vs pediatric recipients. == Table 1. == Clinical Characteristics and Immunosuppression in the Study Groups In group 1, the initial immunosuppressive protocol included FK 506 and Prednisone (Pred) in 20 patients. cyclosporine (CyA). Pred and Imuran in 16 patients, and CyA and Pred in 7 patients. In group 2, all 73 patients received FK 506 and Pred immunosuppression: 28 patients also DNAPK received Imuran (Table 1). Mean follow-up was 28 months (range, 20 to 38 months) for group 1, and 13.8 months (range 2.1 to 31 months) for group 2. The following laboratory tests were performed before transplantation. daily while the patient was in the hospital. and at least weekly for the first 6 months posttransplantation: CBC with differential, electrolytes, BUN, creatinine, glucose, liver-function profile, cholesterol, calcium, phosphorus, uric acid, and magnesium. Before transplantation, CMV titers were measured in all recipients and kidney donors; herpes simplex and Epstein-Barr virus titers were also measured. Specimens of urine, buffy coat, and throat swabs were collected at weekly intervals until discharge, at regular outpatient appointments, and during any subsequent hospital admission to rule out CMV. Specimens from other sites (ie, gastrointestinal biopsies, renal biopsies, bronchoalveolar lavage) were also processed when invasive CMV disease was investigated. Samples were tested for CMV by conventional cell-culture methods and by shell vial assay for early CMV antigen detection. In addition, quantitation of CMV IgG and IgM was also performed with an automated immunofluorescent test. Asymptomatic CMV infection (ACI) was defined as antibody seroconversion not attributable to globulin infusion, and/or viral shedding, and/or positive early antigen detection or positive culture. without symptoms. Symptomatic CMV disease (SCD) was classified as viral syndrome, localized CMV disease, or disseminated CMV disease.8Viral syndrome was considered as the association of laboratory documentation of CMV infection and fever > 38C for 2 or more days with either atypical lymphocytosis > 3%. white cell count <4000/mm,3or platelet count < 100,000/mm.3Localized CMV disease was defined as the invasion of a single organ determined histopathologically and/or by culture of virus from tissue. Disseminated CMV was considered to be a tissue involvement of two or more noncontiguous sites. Disease severity was based on six features defined previously by Simmons;9(1) prolonged fever (temperature >38.3C for more than 7 days); (2) diffuse pulmonary infiltrate; (3) gastrointestinal bleeding; (4) pancreatitis; (5) transplant nephrectomy; (6) development of another systemic infection. Patients with severe CMV disease had KT182 at least three of these six features; patients with moderate disease had two of these features; mild disease was defined by the presence of not more than one of these features. Proportions were analyzed using chi-square or Fishers Exact Test when appropriate. A significant difference was defined asp< .05. == RESULTS == The overall rates of ACI and SCD were 5% and 32%, respectively. The incidence of SCD differed significantly between group 1 (47%) and group 2 (23%) (P= .01). The median day for SCD KT182 diagnosis was 67 days (range, 25 to 178 days) in group 1 and 87 days (range, 14 to 365 days) in group 2. The rate of ACI did not differ significantly between group 1 (1%) and group 2 (7%) (P= .41). In both groups, localized CMV disease was the most frequent clinical manifestation (Table 2) and was most frequently documented in the gastrointestinal tract. However. CMV pneumonia was observed only in group 1. == Table 2. == CMV Disease: Manifestations and Sites In group 1, moderate to.