title: Interrelationships among quantity of human cytomegalovirus (HCMV) DNA in blood, donor-recipient serostatus, and administration of methylprednisolone as risk factors for HCMV disease following liver transplantation.
abstract: Longitudinal analysis of 162 liver transplant recipients identified 51 patients who were viremic. Virus load was determined in 47 of these patients using quantitative-competitive polymerase chain reaction. Peak virus load was significantly higher in 20 symptomatic patients than 27 asymptomatic patients (P < .0001). Elevated virus load, donor seropositivity, and total methylprednisolone dosage were risk factors for human cytomegalovirus (HCMV) disease (odds ratio [OR], 2.22/0.25 log10 increase in virus load, P = .001; OR, 4.11, P = .05; OR, 1.30/1-g increment in methylprednisolone, P = .01). Methylprednisolone and virus load were independent risk factors in a multivariate analysis (OR, 2.70/1-g increase, P = .003; OR, 1.61/0.25 log10 increase, P = .03, respectively). Virus loads of 10(4.75)-10(5.25) genomes/mL of blood were associated with an increased disease probability; the latter was shifted to lower virus loads with increasing quantities of methylprednisolone. These data illustrate the central role of virus load in HCMV pathogenesis.
authors.affiliation: Department of Virology, Royal Free Hospital and School of Medicine, London, United Kingdom.
authors.forename: A V
authors.initials: AV
authors.lastname: Cope
authors.forename: C
authors.initials: C
authors.lastname: Sabin
authors.forename: A
authors.initials: A
authors.lastname: Burroughs
authors.forename: K
authors.initials: K
authors.lastname: Rolles
authors.forename: P D
authors.initials: PD
authors.lastname: Griffiths
authors.forename: V C
authors.initials: VC
authors.lastname: Emery
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood / Q000276:immunology; D002648:Child; D003587:Cytomegalovirus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000209:etiology* / Q000821:virology; D004279:DNA, Viral / Q000097:blood* / Q000235:genetics; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects*; D008137:Longitudinal Studies; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D019562:Viral Load
chemical_list: D000914:Antibodies, Viral; D004279:DNA, Viral; D007166:Immunosuppressive Agents; D008775:Methylprednisolone