ASSOCIATION OF CYTOMEGALOVIRUS-INFECTION WITH POSTTRANSPLANTATION CARDIAC REJECTION AS STUDIED USING THE POLYMERASE CHAIN-REACTION

The relationship between cytomegalovirus (CMV) infection and cardiac a llograft rejection is controversial, some authors reporting a signific ant association, others not, on the basis of the results of convention al virological diagnosis by culture or serology. This problem was rein vestigated in 88 patients using a semi-quantitative nest polymerase ch ain reaction (PCR) procedure for detecting CMV DNA in endomyocardial b iopsy specimens. Significantly more positive biopsies were obtained fr om patients with moderate (grade 2; P = 0.02) or severe (grade 3a-4; P = 0.03) rejection than with no or mild (grade 0-1b) rejection, wherea s there was no significant association between rejection and CMV as di agnosed by virus isolation from urine, throat or blood, or by the dete ction of CMV-IgM. PCR-positive biopsies originated most frequently fro m CMV-antibody positive recipients (R+) of hearts from seropositive do nors (D+), in association with moderate or severe rejection rather tha n with mild or no rejection The detection of CMV in the heart thus see med to be related more to R+D+ serological status than to severity of rejection, that is, to circumstances that favoured co-infection with s trains of CMV from both donor and recipient. Studies on sequential bio psy specimens from selected patients also provided evidence that CMV i nfection and rejection were not always related events. The PCR was abl e to differentiate latent from active CMV infection; moreover, some se ronegative individuals gave repeatedly positive biopsies, thereby supp orting the work of others that some patients undergo CMV infection wit hout mounting a detectable antibody response. The use of the PCR provi ded additional and more definitive information linking CMV and post-tr ansplantation cardiac rejection when compared to conventional methods of viral diagnosis which were less suitable as correlates of deep seat ed focal infection. (C) 1994 Wiley-Liss, Inc.