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  • 1 Transplantation and Surgical Clinic, Semmelweis University, Budapest, Hungary
  • 2 Transplantation and Surgical Clinic, Semmelweis University, Baross u. 23–25, H-1082, Budapest, Hungary
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Abstract

Cytomegalovirus infection is a major infectious complication of transplant recipients, causing significant morbidity and mortality. It is possible to treat this infection effectively only if we know the direct and indirect effects of it, if we take the risk-factors into account, and use sensitive and reliable diagnostic methods for early establishment of diagnosis. In order to avoid severe CMV-infection, it is possible to administer prophylactic therapy. For prophylaxis planning it is important to know the CMV-seroprevalence of Hungarian population and its characteristics. Our results have shown that the seroprevalence of Hungarian population is high: 86%. The primary CMV-infection in Hungary occurs in childhood or in early adulthood, till age of 20 years the seroprevalence is 72%. CMV-seronegative recipients should be transplanted using organs of seronegative donors, however, the chance obtaining the graft from a CMV-seronegative donor was shown to be 2% only. Since such seromatching is rear, we have to know that the constellation of negative recipient and positive donor is the highest risk-factor for developing severe primary CMV-infection. While investigating data of 147 CMV-seronegative recipients from high-risk group it has been established that CMV-infection prophylaxis is essential for high risk patients in the early post-transplant period of 3 months, the administration of any of investigated prophylactic protocols is advantageous in comparing with prophylaxis free management of those patients (P=0.006). The study has also proven that monoprophylaxis with ganciclovir or valganciclovir is the most effective and cost-effective procedure as compared to other protocols (P=0.006). It is important to take into consideration that in prophylactic groups the “late-onset” CMV-infection occurred often (25.4%), and that there were no signs of seroconversion after the primary CMV-infection in 14% of the patients. For the first time it has been found and proven that the female sex is a risk factor for CMV-infection (P=0.0006). Genetic variability influences susceptibility to infectious diseases and HLA-molecules are critical for viral antigen uptaking, processing and presenting. Our data of 129 of high-risk patients suggest that recipients positive for HLA-DQ3 are more susceptible to CMV-infection than a comparable group of patients negative for this HLA-type. This result was not due to rejection and/or treatment for rejection and was not influenced by induction therapy or number of HLA-mismatches. The multivariate Cox Regression analysis has shown that HLA-DQ3 positivity is an independent predictor of primary CMV-infection in CMV-seronegative recipients with seropositive donor grafts (P=0.001). The cognition of HLA-DQ3 is useful in the prediction of acute CMV-infection in high-risk patients, and should influence the planning of the patients' management.

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