Clinical course and symptoms of cytomegalovirus (CMV) infections in the era of current immunosuppressive and antiviral drugs are poorly described. In our clinical experience, gastrointestinal symptoms are more common than previously documented. Our aim was to characterize all CMV infections in a large cohort of kidney transplant recipients.

Among 1129 kidney transplant recipients transplanted between 2004-2011 in CharitÉ UniversitÄtsmedizin Berlin and Helsinki University Hospital, 297 patients with CMV infection were characterized in detail. CMV infections were diagnosed in the majority of patients with quantitative PCR. Valganciclovir prophylaxis was routinely used only in D+/R- patients.

CMV disease occurred in 217/1129 patients (19.2%), and CMV infection in 297/1129 patients (26.3%). Gastrointestinal symptoms were the most common symptoms of CMV infection. Other symptoms are presented in Figure 1.

* P=0.01, ** P<0.001 (CMV seropositive patients compared to CMV seronegative). Tissue-invasive CMV gastroenteritis was confirmed in 11% and CMV pneumonia in only 1% of patients with CMV disease. Only one patient died due to CMV infection (mortality 0.3%). Recurrent CMV infection occurred in 33% patients. In a multivariable model, virus-related factors or the use of secondary prophylaxis did not predict the risk of recurrence.

CMV disease remains a common problem after kidney transplantation. Gastrointestinal symptoms were strikingly common, especially in patients with primary CMV infection, whereas bone marrow suppression, hepatopathy, or malaise were seen less frequently.

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