title: Sensitivity of blood and tissue diagnostics for gastrointestinal cytomegalovirus disease in solid organ transplant recipients.
abstract: BACKGROUND
  Gastrointestinal (GI) cytomegalovirus (CMV) disease is the most common manifestation of tissue-invasive CMV infection in solid organ transplant (SOT) recipients, but the diagnostic yields of blood and tissue testing have not been systematically assessed in a large patient cohort.
  
  
  METHODS
  We retrospectively identified consecutive SOT recipients with biopsy-confirmed GI CMV disease who had both tissue and blood (CMV polymerase chain reaction or antigenemia) diagnostic testing performed within 14 days of diagnosis. Descriptive statistics and logistic regression were used to assess the association between patient factors and viremia and the diagnostic yield of tests performed on biopsy specimens.
  
  
  RESULTS
  A total of 101 patients (73% donor seropositive/recipient seronegative [D+/R-], 22% recipient seropositive [R+]) had GI CMV disease (58% upper, 22% lower, and 20% both) at a median of 185 days (range, 21-6345 days) post transplant. In multivariate analysis, R+ CMV serostatus (odds ratio [OR] 0.1 [0.0-0.4], P < 0.001) and diagnosis >6 months post transplant (OR 0.3 [0.1-0.9], P = 0.03) were each independently associated with absence of CMV viremia at time of diagnosis. In the subset of patients (n = 29) in whom both histopathology and viral culture were performed on biopsy specimens, 11 (39%) had CMV detected only by culture and had similar clinical characteristics and outcomes to those with positive histopathology (P > 0.05 for all comparisons).
  
  
  CONCLUSIONS
  The sensitivity of viremia in SOT recipients with GI CMV disease is significantly lower in CMV-seropositive patients and in those >6 months post transplant. Addition of viral culture to endoscopic biopsy specimens significantly increases the diagnostic yield for GI CMV disease.
authors.affiliation: Divisions of Allergy & Infectious Disease, Department of Medicine, University of Washington, Seattle, Washington, USA.|Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Fisher
authors.affiliation: Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: J
authors.initials: J
authors.lastname: Alexander
authors.affiliation: Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: R
authors.initials: R
authors.lastname: Bhattacharya
authors.affiliation: Divisions of Allergy & Infectious Disease, Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Rakita
authors.affiliation: Division of Geriatrics, San Francisco VA Medical Center and University of California, San Francisco, California, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Kirby
authors.affiliation: Divisions of Allergy & Infectious Disease, Department of Medicine, University of Washington, Seattle, Washington, USA.|Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
authors.forename: M
authors.initials: M
authors.lastname: Boeckh
authors.affiliation: Divisions of Allergy & Infectious Disease, Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: A P
authors.initials: AP
authors.lastname: Limaye
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003587:Cytomegalovirus / Q000235:genetics / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000821:virology; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014766:Viremia; D055815:Young Adult
keywords: cytomegalovirus disease; diagnosis; gastrointestinal; sensitivity; solid organ transplant