The clinical use of various blood compartments for cytomegalovirus (CMV) DNA quantitation in transplant recipients with CMV disease.
BACKGROUND
The quantitation of cytomegalovirus (CMV) DNA is a cornerstone in the management of CMV disease in transplant recipients. However, a consensus as to what is the optimal blood compartment for the detection and quantitation of CMV DNA in peripheral blood is nonexistent.


METHODS
With an automated quantitative assay, we have simultaneously quantified the CMV DNA load in whole blood (WB), plasma (PL), peripheral blood leukocytes (PBL), and peripheral blood mononuclear cells (PBMC) in 319 samples from 17 transplant recipients with 19 episodes of CMV disease that were treated with 2 weeks of intravenous ganciclovir.


RESULTS
Higher levels of CMV DNA were observed in WB than PL (PL minus WB mean difference, 0.67 log; 95% confidence interval, -1.02 to -0.32; P=0.0009). This observation was most evident before treatment with intravenous ganciclovir (pretreatment geometric mean CMV DNA was 45,412 copies per ml of WB vs. 14,995 copies per ml of PL). In contrast, the CMV DNA levels between PBL and PBMC were highly comparable throughout the course of CMV disease and its treatment. Intravenous ganciclovir exerted a uniform effect on the four blood compartments with no statistically significant difference in the degree and rate of CMV DNA decline between WB and PL and between PBL and PBMC.


CONCLUSIONS
Although our study demonstrates the adequacy of all blood compartments for CMV DNA quantification, the higher sensitivity of WB and its yield of higher CMV DNA render it an optimal sample for monitoring CMV DNA load during CMV disease in immunocompromised patients.
Razonable
Raymund R
RR
Division of Infectious Diseases and Internal Medicine and Transplant Center, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Brown
Robert A
RA
Wilson
Jennie
J
Groettum
Cynthia
C
Kremers
Walter
W
Espy
Mark
M
Smith
Thomas F
TF
Paya
Carlos V
CV
D000998:Antiviral Agents / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000175:diagnosis*; D004279:DNA, Viral / Q000097:blood* / Q000302:isolation & purification; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D007962:Leukocytes / Q000821:virology; D007963:Leukocytes, Mononuclear / Q000821:virology; D008214:Lymphocytes / Q000821:virology; D016377:Organ Transplantation; D011183:Postoperative Complications / Q000175:diagnosis; D012044:Regression Analysis; D015203:Reproducibility of Results
D000998:Antiviral Agents; D004279:DNA, Viral; D015774:Ganciclovir