The Indirect Effects of Cytomegalovirus Infection on the Outcome of Organ Transplantation

The evolution of organ transplantation from an interesting experiment in human immunobiology to a highly successful, practical approach for rehabilitating patients with end-stage kidney, heart, liver, and lung disease is one of the great successes of modern medicine. However, the very success of organ transplantation has created in an ever-increasing number of individuals a series of phenomena that have no precedent in medicine or biology: (1) the long-term presence of vascularized organs that differ from the host at a variety of major and minor histocompatibility loci, (2) the lifelong intake of broadly active immunosuppressive agents to permit the continued function of the allograft, and (3) the reactivation, tissue invasion, and continued proliferation of certain infectious agents, particularly the herpes group of viruses, within the individual. The net result of these phenomena are a series of clinical syndromes and effects that are unique to the transplant recipient. Among the most important