THE ROLE OF PCR IN THE DIAGNOSIS AND MANAGEMENT OF CMV IN SOLID-ORGANRECIPIENTS - WHAT IS THE PREDICTIVE VALUE FOR THE DEVELOPMENT OF DISEASE AND SHOULD PCR BE USED TO GUIDE ANTIVIRAL THERAPY
Mm. Abecassis et al., THE ROLE OF PCR IN THE DIAGNOSIS AND MANAGEMENT OF CMV IN SOLID-ORGANRECIPIENTS - WHAT IS THE PREDICTIVE VALUE FOR THE DEVELOPMENT OF DISEASE AND SHOULD PCR BE USED TO GUIDE ANTIVIRAL THERAPY, Transplantation, 63(2), 1997, pp. 275-279
Cytomegalovirus remains a significant source of morbidity and mortalit
y in immunocompromised hosts. The increased sensitivity of molecular d
iagnostic techniques (PCR, antigenemia) has resulted in our ability to
detect viral replication earlier in the posttransplant period, before
the onset of symptoms. With the advent of effective antiviral therapy
, ''preemptive therapy,'' guided by sensitive, early and specific pred
ictors of CMV disease, has become a realistic objective. Although mult
iple studies have analyzed the sensitivity and specificity of these te
sts, their predictive value for the development of disease has not bee
n defined, The purpose of this study was to evaluate the predictive va
lue of a positive CMV PCR in the setting of solid abdominal organ tran
splantation. A total of 476 PCR assays were performed on 134 transplan
t recipients (102 kidney, 19 kidney/pancreas, 11 liver, 2 other) eithe
r as protocol serial samples or as dictated by clinical events, All sa
mples were concomitantly analyzed using standard virological assays fo
r CMV including culture, shell vial, and serology, Patients with any C
MV seropositive donor/recipient (D/R) combination received ganciclovir
prophylaxis in conjunction with antilymphocyte induction for 14 days.
No subsequent CMV prophylaxis was used. The positive predictive value
was 55% in all seropositive donor/recipient combinations. The highest
risk group (seronegative recipient of seropositive donor) showed the
highest positive predictive value, whereas seropositive recipients of
either seropositive or seronegative donors showed positive predictive
values of 45% and 25%, respectively, Negative predictive value was 100
% for all groups, Early detection of CMV infection has important impli
cations for patient management, including preemptive therapy, which ca
n be guided by PCR, especially in high risk (D+/R-) patients.