QJM, Vol 91, Issue 3 185-189, Copyright © 1998 by Oxford University Press
S Pouria, OI State, W Wong and BM Hendry
Transplant renal artery stenosis (TRAS) is a significant cause of graft
dysfunction, with no clearly defined aetiology. Evidence suggests a role
for cytomegalovirus (CMV) infection in cardiac transplant vasculopathy and
in native coronary artery restenosis after angioplasty. We investigated the
relationship between CMV infection after renal transplantation and
subsequent development of TRAS. Of 917 patients receiving renal transplants
at a single centre from 1978 to 1994, 75 had TRAS diagnosed by angiography.
Each was paired with a control transplanted patient with no TRAS, matched
for age, sex, year of transplant and number of grafts. Incidence of CMV
infection between transplantation and the time of diagnosis of TRAS was
assessed in both groups, using clinical and serological criteria to assign
patients to three groups: definite CMV infection (CMV-DEF), possible
infection (CMV- POSS) and no evidence of infection (CMV-NUL). CMV-DEF was
significantly more common in TRAS than in controls (36 vs. 12,
respectively, p < 0.001) and CMV-NUL was less common (TRAS 15, controls
33). We have previously reported an increased incidence of acute rejection
in patients with TRAS. The subset of patients with no rejection episodes
also had significantly more CMV-DEF cases in the TRAS group (54%) than in
controls (10%) (p = 0.002). The data are consistent with the hypothesis
that CMV infection can contribute to the development of TRAS. The
relationship between CMV and TRAS did not arise from an excess of
anti-rejection treatment in the TRAS group. CMV-induced large- vessel
damage in immunosuppressed patients may occur through local infection and
the mitogenic actions of viral gene products within cells of the vessel
wall.
ORIGINAL PAPERS
CMV infection is associated with transplant renal artery stenosis
Department of Medicine, King's College School of Medicine and Dentistry, King's College London, UK.
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