title: Monitoring human cytomegalovirus (HCMV) in HCMV-seropositive orthotopic liver-transplant recipients by means of quantitative real-time polymerase chain reaction.
abstract: OBJECTIVE
  Human cytomegalovirus can be reactivated after orthotopic liver transplantation in patients who are seropositive for cytomegalovirus. Whether those cytomegalovirus-seropositive patients require immediate posttransplant (anti)- cytomegalovirus prophylactic therapy or preemptive treatment as opposed to deferred treatment remains controversial. The aims of our study were to evaluate the relevance of cytomegalovirus monitoring with quantitative real-time polymerase chain reaction in whole blood and to analyze the factors that determine the treatment of the first episode of cytomegalovirus infection with intravenous ganciclovir in seropositive liver-transplant patients.
  
  
  METHODS
  Forty-two cytomegalovirus-seropositive liver-transplant patients were assessed for cytomegalovirus DNAemia every 2 weeks until posttransplant day 90 and every 3 to 4 weeks until day 180. Biochemical and hematologic parameters were also prospectively monitored.
  
  
  RESULTS
  Cytomegalovirus DNAemia was detected at least once in 27 patients (64%). Treatment was initiated in 12 patients (group 1) but not in 15 others (group 2). Median HCMV viral loads of the first positive and the highest DNAemia were statistically higher in group 1 than in group 2 (P = 0.01). Univariate analysis of DNAemia showed that alkaline phosphatase levels were significantly higher in group 1 than in group 2 (P = .0011) and that hemoglobin levels were significantly lower in group 1 than in group 2 (P = .0443). The results of multivariate analysis showed that the only factor that predicted the treatment of the first episode of HCMV DNAemia was a level of alkaline phosphatase greater than 150 IU/L [odds ratio, 20; range, 1.97-203.32; P = .01].
  
  
  CONCLUSIONS
  A combination of criteria, including viral-load kinetics, clinical factors, alkaline phosphatase levels (in particular), and the patient's immune condition, is required to efficiently monitor patients who are seropositive for cytomegalovirus after orthotopic liver transplantation.
authors.affiliation: Laboratoire de Virologie, Hopital Purpan, CHU Toulouse, Toulouse, France;
authors.forename: Catherine
authors.initials: C
authors.lastname: Mengelle
authors.forename: Florence
authors.initials: F
authors.lastname: Abravanel-Legrand
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
authors.forename: Sophie
authors.initials: S
authors.lastname: Alain
authors.forename: Grégoire
authors.initials: G
authors.lastname: Basse
authors.forename: Adèle
authors.initials: A
authors.lastname: Pillet
authors.forename: Laurence
authors.initials: L
authors.lastname: Lavayssière
authors.forename: Bertrand
authors.initials: B
authors.lastname: Suc
authors.forename: Jacques
authors.initials: J
authors.lastname: Izopet
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
mesh_terms: D003404:Creatinine / Q000097:blood; D003587:Cytomegalovirus / Q000235:genetics* / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000453:epidemiology*; D004784:Environmental Monitoring / Q000379:methods; D062665:Epidemiological Monitoring; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D016133:Polymerase Chain Reaction / Q000379:methods; D011183:Postoperative Complications / Q000821:virology*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D003404:Creatinine