PREDICTION OF RECURRENT CYTOMEGALOVIRUS DISEASE AFTER TREATMENT WITH GANCICLOVIR IN SOLID-ORGAN TRANSPLANT RECIPIENTS

CMV disease often recurs after initially successful antiviral therapy. We retrospectively determined in a group of 36 organ transplant patie nts whether clinical, virological, or immunological parameters during or shortly after cessation of antiviral therapy can identify those at high risk of relapse. Eleven of 36 patients had recurrent CMV disease after ganciclovir therapy. Neither donor or recipient CMV serostatus, type of baseline immunosuppression, antirejection treatment, indicatio n for antiviral treatment, nor presence of CMV in the blood during or after therapy (as detected by antigenemia, viremia, or a positive poly merase-chain-reaction signal) were helpful in identification of patien ts with subsequent relapse. However, quantitative monitoring of antige nemia fascilitated early diagnosis of relapse since 10 of 11 patients with greater-than-or-equal-to 10 antigen-positive cells per 50.000 PMN s relapsed (99.1%, 95% CI 58.7-99.8). IgM and IgG responses against CM V during primary infection were comparable in relapsing and nonrelapsi ng patients. During secondary infection relapse occurred only in the 4 patients with the lowest IgG responses. The number of activated CD8br ight lymphocytes in the peripheral blood as determined by flow cytomet ry at the end of antiviral therapy was a strong risk factor for the su bsequent clinical course: 6 of 7 patients (85.7%, 95% CI 42.1-99.6%) w ith <100x10(3) HLADR+CD8bright cells/ml blood relapsed, while 8 of 8 ( 100%, 95% CI 63-100) with activated CD8bright cells above that level r emained asymptomatic (P<.025). These data show that patients with a hi gh risk of relapse of CMV disease can be identified at the end of anti viral therapy.