A PROSPECTIVE-STUDY OF RAPID METHODS OF DETECTING CYTOMEGALOVIRUS IN THE BLOOD OF RENAL-TRANSPLANT RECIPIENTS IN RELATION TO PATIENT AND GRAFT-SURVIVAL

Eighty-five renal transplant recipients were prospectively monitored f or CMV infection up to 4 months post-transplantation by virus isolatio n from leukocytes, CMV antigen detection (pp65) in peripheral blood le ukocytes (PBL), polymerase chain reaction (PCR) of alkaline treated pl asma (P-PCR), PCR of extracted DNA from PBL (L-PCR) and serology. Addi tionally univariate and multivariate analyses of risk factors for pati ent and graft survival up to 4 yr post-transplantation were performed. The incidence of CMV infection was 78% and of CMV disease 33%. Antige n detection in PBL was positive before or at onset of symptoms in 23/2 4 (96%) evaluable patients with CMV disease. The corresponding figures for virus isolation were 22/24 (92%), P-PCR 21/24 (88%) and for L-PCR 18/24 (75%). The percentage of negative samples in patients without C MV disease was 89% for the antigen test, 92% for L-PCR and 83% for vir us isolation and P-PCR. One rapid test (antigen test, P-PCR or L-PCR) was positive at a median of 16 d before the onset of symptoms. The ant igen test was generally the first rapid test to become positive. CMV d isease did not affect graft survival in the multivariate analysis but was associated with decreased patient survival.