The impact of cytomegalovirus infection and disease on rejection episodes in renal allograft recipients.

Cytomegalovirus (CMV) infection and disease are potential risk factors for acute allograft rejection in renal transplant recipients. The present study specifically addresses this issue. From October 1994 to July 1997, 477 consecutive renal allograft recipients (397 first transplants and 80 retransplants) were included in the study. CMV infection (cytomegalovirus pp65 antigen in leukocytes) and disease (infection and clinical symptoms or signs of disease) were examined prospectively for 3 months. No CMV prophylaxis was given, and CMV disease was treated with intravenous (i.v.) ganciclovir. The retransplantation of four patients transplanted twice during the study and 22 patients receiving kidneys from human leucocyte antigen (HLA)-identical siblings were excluded from statistical analysis. Rejections were evaluated clinically [277(61%)] and 173 (38%) also had a biopsy verified rejection. CMV infection occurred in 64% of the patients and 24% experienced CMV disease. In a multiple time-dependent Cox analysis, CMV infection and CMV disease were independent significant predictors for clinical acute rejections, RR = 1.6 (1.1-2.5, p = 0.02) and RR = 2.5 (1.2-5.1, p = 0.01), respectively. Among 173 patients with biopsy verified rejection, 72% of the patients had tubulointerstitial rejection whereas 28% had a vascular rejection. CMV disease, but not CMV infection was a predictor of tubulointerstitial rejection, RR = 3.1 (1.1-9.3, p = 0.04). CMV infection and disease are independent risk factors for clinical acute rejection in kidney allograft recipients. CMV disease is an independent risk factor for biopsy verified acute tubulointerstitial rejection in kidney allograft recipients.

Induction of cytokine production by different Staphylococcal strains.

In light of the important role of cytokines in the pathogenesis of bacterial infections, we analyzed the cytokine production induced by different Staphylococcus aureus (S. aureus), S. epidermidis and S. saprophyticus strains in human mononuclear cells (MNCs). MNCs secreted high amounts of interleukin-1beta (IL-1beta) and IL-6 proteins in responses to stimulation with all three species of Staphylococci. Interestingly, a large majority of the S. aureus strains induced significantly higher IL-12 and interferon (IFN) titers than did the S. epidermidis and S. saprophyticus strains. The RNase protection assay revealed high increases in IL-1alpha, IL-1 beta, IL-1 receptor antagonist, IL-6 and IL-12 p40 transcript levels in MNCs stimulated with Staphylococci. All of the tested Staphylococcal strains proved highly efficient in mediating the induction of these genes. Reverse transcriptase polymerase chain reaction (RT-PCR) analysis indicated considerable increases in IFNA transcript levels in MNCs stimulated with S. aureus strains, while only a very weak expression was stimulated by S. epidermidis and S. saprophyticus. These results confirm that heat-killed Staphylococci exert strong immunomodulatory effects, and suggest that the contribution of T-helper 1 (Th(1)) cells to the immune response may be much extensive in infections caused by S. aureus strains, due to their high IL-12p70 and IFN-alpha-inducing activities.