title: Pre-emptive therapy for the cytomegalovirus infection after liver transplantation in endemic areas and its optimal diagnostic method.
abstract: BACKGROUND
  The incidence of positive cytomegalovirus (CMV) IgG tests among Asian populations is high. Both universal prophylaxis and pre-emptive therapy (PT) have been recommended for the moderate-risk group (D+/R+), whose incidence of CMV infection has been reported variously, and for whom the optimal diagnostic method has not been firmly established. Herein, we sought to analyze our experience with CMV infections using PT and to discuss the optimal diagnostic method.
  
  
  METHODS
  We retrospectively, analyzed 32 consecutive liver transplant recipients between December 2009 and April 2012 for clinicopathologic data including mortality and rejection rates, comparing 2 diagnostic tools for CMV: pp65 antigen assay and real-time reverse-transcriptase polymerase chain reaction (RT-PCR).
  
  
  RESULTS
  Twenty-one patients (65.6%) were positive for the CMV antigen assay, and 13 (40.6%) had positive RT-PCR results. There were no cases of CMV disease during the follow-up and no difference in rejection (P = .529) or mortality (P = .471) rates with regard to PCR positivity. The mean diagnosis time was 26.5 days postoperative. Among the patients who exhibited negative RT-PCR results, 7 (41.18%) were positive on the pp65 antigen assay.
  
  
  CONCLUSIONS
  CMV infection rates were higher when compared to same-risk population from Western countries. As a diagnostic tool for CMV infection, screening with the pp65 antigen assay and confirmation with real-time RT-PCR seemed to provide an optimal diagnostic tool.
authors.affiliation: Division of Hepatobiliary and Pancreas Surgery & Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, Korea.
authors.forename: W
authors.initials: W
authors.lastname: Ji
authors.forename: D-S
authors.initials: DS
authors.lastname: Kim
authors.forename: S-W
authors.initials: SW
authors.lastname: Jung
authors.forename: Y-D
authors.initials: YD
authors.lastname: Yu
authors.forename: S-O
authors.initials: SO
authors.lastname: Suh
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000188:drug therapy*; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000998:Antiviral Agents