Monitoring levels of human cytomegalovirus DNA in blood after liver transplantation.
We evaluated a semiquantitative PCR assay prospectively in 40 liver transplant recipients as an aid in making a prompt diagnosis of cytomegalovirus (CMV) infection. For 2 months after transplantation, clinical specimens from patients were tested weekly by PCR, virus isolation from peripheral blood and urine, and CMV serology. The incidence of active CMV infection was 70%. The levels of CMV DNA determined by hybridization of PCR samples and densitometric scanning of blots were assigned a score of 1 to 4 by comparison with four external standards amplified in parallel and corresponding to a range of 80 to 80,000 genomes. The first detection of CMV in blood by PCR occurred at a mean of 15 days, and high-level PCR scores of 3 or 4 were obtained 21 days after transplantation, whereas viremia occurred 33 days after transplantation. Significantly higher levels of CMV DNA were seen in patients with CMV disease (P < 0.05) than in asymptomatic patients. The prevalence of symptomatic CMV infection was 30%. The positive predictive value of PCR was 48%, while the negative predictive value was 100%. After treatment, the clearance of CMV DNA was always observed and the disappearance of symptoms occurred concomitantly with undetectable PCR signals.
Drouet
E
E
Unité d'Infectiologie, Institut Pasteur de Lyon, France.
Colimon
R
R
Michelson
S
S
Fourcade
N
N
Niveleau
A
A
Ducerf
C
C
Boibieux
A
A
Chevallier
M
M
Denoyel
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D001483:Base Sequence; D003587:Cytomegalovirus / Q000235:genetics* / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000209:etiology / Q000821:virology; D017931:DNA Primers / Q000235:genetics; D004279:DNA, Viral / Q000097:blood* / Q000235:genetics*; D005069:Evaluation Studies as Topic; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D008969:Molecular Sequence Data; D016133:Polymerase Chain Reaction / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D014766:Viremia / Q000175:diagnosis / Q000209:etiology / Q000821:virology
D017931:DNA Primers; D004279:DNA, Viral