Organs transplanted from donors who are seropositive for CMV are a well-known source of CMV infection in their recipients. Such organs appear to contain latent virus that reactivates following transplantation. However, not all grafts from seropositive donors are observed to transmit CMV, either because of differing immune function among recipients, or content of transmissible virus among donors. To explore these variables, we conducted a 3-year prospective survey involving 140 CMV-seronegative kidney and heart recipients, using a sensitive assay for CMV antibody to classify donors and recipients, and detect posttransplant primary infection. We found that none of 64 recipients of a CMV-seronegative organ, and 40 of 68 (58%) recipients of a CMV- seropositive organ, developed primary CMV infection. Analysis of recipient factors in the latter group showed no significant differences in underlying disease, age, and immunosuppressive therapy between the 58% who did develop CMV infection after receiving a CMV-sero- positive organ, and the 42% who did not. In 9 pairs of recipients, each pair of whom received organs from the same CMV-seropositive cadaver donor, there was complete concordance of outcomes within pairs. In 4 pairs, both recipients developed CMV infection, whereas in the remaining 5 pairs, neither recipient did so. These observations suggest that only a subset of CMV-seropositive donors carry latent CMV that reactivates posttransplant, and that donor factors other than seropositivity are important in determining the infectivity of transplanted organs.
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