LOW CORRELATION OF HUMAN CYTOMEGALOVIRUS DNA AMPLIFICATION BY POLYMERASE CHAIN-REACTION WITH CYTOMEGALOVIRUS DISEASE IN ORGAN TRANSPLANT RECIPIENTS

Seventy-five organ transplant recipients underwent prolonged virologic al and serological follow-up for early detection of human cytomegalovi rus (HCMV) infection after transplantation. HCMV DNA detection by nest ed polymerase chain reaction (PCR) and HCMV early structural antigen ( pp65) detection were carried out in 576 peripheral blood leucocyte (PB L) samples. Furthermore, 563 blood specimens were investigated by a co mmercially available enzyme-linked immunosorbent assay (ELISA) for the detection of specific immunoglobulins G, M, and A against HCMV struct ural antigens. In eight of nine symptomatic organ transplant recipient s, HCMV DNA was detected in one or more consecutive blood samples. HCM V DNA PCR was also positive in one or more samples from eight patients who never developed HCMV-related symptoms. HCMV pp65 antigen was dete cted almost exclusively in PBL samples from organ transplant recipient s suffering from HCMV disease. However, antigenaemia was not detected in four PCR positive patients presenting clinical signs attributable t o HCMV infection. Two of the initially HCMV DNA positive samples were not confirmed by retesting and hybridisation. The results of the prese nt study demonstrate that despite the high specificity of nested PCR, HCMV DNA may be detected in the absence of clinical symptoms attributa ble to HCMV infection. In asymptomatic reactivation, limited replicati on of viral DNA may be responsible for positive results of PCR without any clinical relevance. In this context, pp65-antigen detection from PBL seems to have a better prognostic value, but is not always detecte d when clinical symptoms are present. (C) 1994 Wiley-Liss, Inc.