Monitoring of human cytomegalovirus, HHV-6 and HHV-7 infection in kidney transplant recipients by molecular methods to predict HCMV disease after transplantation: a prospective study.
OBJECTIVE
Recently, highly sensitive molecular assays to detect HCMV, HHV-6 and HHV-7 have been developed but their ability to detect patients at high risk for disease is unclear.


METHODS
The positive predictive values (PPV) of pp65-antigenemia, quantitative plasma DNA and pp67-mRNA for CMV-disease were prospectively compared in 82 transplant recipients (72 renal, 10 pancreas-kidney) without CMV-prophylaxis. In addition, the prevalence of HHV-6 and HHV-7 infection were assessed using qualitative PCR. The assays were performed weekly.


RESULTS
Three patients (3,7%) developed CMV-disease and were effectively treated. They were positive in all three CMV-assays. The PPVs of pp65-Ag, DNA viral load and pp67-mRNA were 33%, 20% and 25% in CMV-positive and 100%, 67% and 50% in seronegative recipients. Sensitivity and negative predictive value were 100% for all assays. Using cut-offs, PPVs were 75% (pp65-Ag > or = 20/200.000 cells) and 100% (PCR > or =30.000 copies/ml). Transfusion of >2 packed red cells, rejection and non-functioning graft were risk factors for CMV Five patients and one patient were positive for HHV-6 and HHV-7 resp.; both were symptomless and did not have a HCMV infection.


CONCLUSIONS
Therefore, pp65-antigenemia and plasma PCR with a cut-off could be useful for monitoring preemptive therapy.
Rayes
Nada
N
Department of General Surgery, Charite Universitätsmedizin Campus Virchow, Humboldt University of Berlin. nada.rayes@charite.de
Seehofer
Daniel
D
Lullius
Stefan G
SG
Stein
Angela
A
May
Gottfried
G
Kahl
Andreas
A
Frei
Ulrich
U
Neuhaus
Peter
P
Meisel
Helga
H
D003587:Cytomegalovirus / Q000235:genetics; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000209:etiology; D004279:DNA, Viral / Q000097:blood; D005821:Genetic Techniques; D015654:Herpesvirus 6, Human; D016199:Herpesvirus 7, Human; D006801:Humans; D016030:Kidney Transplantation; D016035:Pancreas Transplantation; D010750:Phosphoproteins / Q000097:blood; D016133:Polymerase Chain Reaction; D011159:Population Surveillance; D011184:Postoperative Period; D015995:Prevalence; D011446:Prospective Studies; D012333:RNA, Messenger / Q000097:blood; D012307:Risk Factors; D019349:Roseolovirus Infections / Q000175:diagnosis* / Q000453:epidemiology; D012680:Sensitivity and Specificity; D012698:Serologic Tests; D019562:Viral Load; D014763:Viral Matrix Proteins / Q000097:blood
D004279:DNA, Viral; D010750:Phosphoproteins; D012333:RNA, Messenger; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa; C464963:pp67 protein, human cytomegalovirus