DETECTION OF CYTOMEGALOVIRUS DNA IN SERA OF LIVER-TRANSPLANT RECIPIENTS

We prospectively studied the utility of the amplification of cytomegal ovirus (CMV) DNA in the sera of liver transplant recipients in order t o predict symptomatic CMV infection, thus enabling preemptive therapy with antiviral agents. Serum samples obtained at biweekly intervals fr om 20 sequential liver transplant recipients for at least 8 weeks foll owing transplantation were tested by the PCR amplification procedure. Results were correlated with blood and urine cultures, histopathologic al findings from infected organs, and clinical manifestations. Six pat ients (30%) developed symptomatic CMV infection; in five (83%) of thes e patients, CMV DNA was detected prior to symptomatic CMV infection, a nd in one (17%) of these patients, CMV DNA was detected at the time of symptomatic CMV infection. CMV DNA was detected a mean of 13 days (ra nge, 0 to 23 days) prior to the onset of symptomatic CMV infection. In addition, CMV DNA was detected in the sera of four of five patients w ith asymptomatic viremia and two patients with asymptomatic viruria. L astly, the PCR was negative for sera from seven patients with no evide nce of CMV infection. We found that PCR was able to detect the presenc e of CMV DNA in the sera of liver transplant recipients at a sensitivi ty of 92% and a specificity of 100% for CMV infection, while the sensi tivity and specificity for symptomatic infection were 100 and 57%, res pectively.