title: Monitoring of human cytomegalovirus infections in heart transplant recipients by pp65 antigenemia.
abstract: BACKGROUND
  Rapid diagnostic techniques offer the opportunity of early diagnosis of human cytomegalovirus (CMV) infection in immunocompromized patients at risk of developing CMV disease and syndrome. The use of CMV pp65 antigenemia as a predictor of CMV syndrome and disease in heart transplant recipient after induction therapy was studied retrospectively.
  
  
  METHODS
  One hundred and nineteen consecutive heart transplant recipients treated with induction therapy who survived more then 14 d were monitored for CMV infection. Ninety-four recipients were seropositive for CMV. Twenty-five recipients were seronegative for CMV and received grafts from seropositive donors. Pre-emptive therapy was used in seropositive patients when CMV pp65 antigenemia was greater than 50 antigen-positive cells per 2 x 10(5) peripheral blood leukocytes (PBL); prophylactic therapy was done only in seronegative recipient matched with seropositive donor.
  
  
  RESULTS
  High-level CMV pp65 antigenemia (50 antigen-positive cells 2 x 10(5) PBL) occurred in 34% (41 of 119) of patients at a median of 44 d following transplantation. In seropositive recipients, 16% (15 of 94) of patients developed CMV invasive disease or syndrome, and in seronegative recipients 20% (5 of 25) of patients developed CMV disease or syndrome. Sixty-six per cent (62 of 94) of CMV seropositive patients were identified as not requiring pre-emptive therapy. In seropositive and seronegative recipients, the sensibility and negative predictive value of the cut-off level of 50 antigen positive cell for CMV disease and syndrome was 100%. The specificity was 79% and positive predictive value was 49%.
  
  
  CONCLUSIONS
  Because of the excellent sensibility and negative predictive value of the cut-off level of 50 antigen positive cell per 2 x 10(5) PBL, application of pre-emptive therapy guided by high level of CMV pp65 antigenemia in the context of induction therapy allow to omit antiviral therapy in many at risk patients. In the context of pre-emptive and prophylactic therapy, the cut-off level of 50 antigen positive cell do not allow to predict with accuracy the development of CMV disease or syndrome.
authors.affiliation: Service de Chirurgie Cardio-Vasculaire et Thoracique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France. michedubois@hotmail.com
authors.forename: Mario
authors.initials: M
authors.lastname: Sénéchal
authors.forename: Richard
authors.initials: R
authors.lastname: Dorent
authors.forename: Sophie Tezenas
authors.initials: ST
authors.lastname: du Montcel
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Fillet
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Ghossoub
authors.forename: Michelle
authors.initials: M
authors.lastname: Dubois
authors.forename: Alain
authors.initials: A
authors.lastname: Pavie
authors.forename: Iradj
authors.initials: I
authors.lastname: Gandjbakhch
mesh_terms: D000956:Antigens, Viral / Q000097:blood*; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000209:etiology; D016027:Heart Transplantation; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007962:Leukocytes / Q000821:virology; D010750:Phosphoproteins / Q000097:blood*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014763:Viral Matrix Proteins / Q000097:blood*
chemical_list: D000956:Antigens, Viral; D007166:Immunosuppressive Agents; D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa