DEMONSTRATION OF CYTOMEGALOVIRUS BY POLYMERASE CHAIN-REACTION AFTER LIVER-TRANSPLANTATION

The polymerase chain reaction (PCR) is a highly sensitive and specific technique for detection of cytomegalovirus DNA. With this method we p rospectively analyzed buffy coat leukocytes at weekly intervals over 3 months in 60 patients after liver transplantation (LTX). The PCR resu lts were correlated with the pretransplant donor/recipient CMV antibod y status and with the occurrence of CMV-induced disease. Thirty-three of 60 (55%) patients became PCR-positive during their posttransplant c ourse. None of the 27 patients with permanent negative PCRs developed CMV disease. Of 33 patients with positive PCRS, 13 (39%) became ill. C MV disease developed in 9 of 22 (41%) antibody-negative recipients but only in 4 of 38 (10%) seropositive graft recipients. The incidence of CMV disease was 75% (9 of 12 patients) in seronegative recipients who converted to positive PCR results and 19% (4 of 21 patients) in serop ositive patients with positive PCR findings. The predictive value of a positive PCR was 75% in seronegative patients but it was low (19%) in seropositive recipients. The predictive value of a negative PCR is 10 0%. Thus, PCR determinations are useful in identifying patients who wi ll not develop CMV disease and in narrowing down the number of individ uals who will become sick. Further, PCR is a helpful tool in the follo w-up of patients under antiviral treatment.