A RAPID IMMUNOCYTOCHEMICAL ASSAY FOR CMV DETECTION IN PERIPHERAL-BLOOD OF ORGAN-TRANSPLANTED PATIENTS IN CLINICAL-PRACTICE

This study describes clinical experience with a rapid method for diagn osis of cytomegalovirus infection in organ-transplanted patients, base d on the detection of CMV-specific antigens in peripheral polymorphonu clear cells with a mixture of monoclonal antibodies. This CMV-pp65 ass ay was formerly called the ''CMV immediate early antigen assay.'' A gr oup of 180 organ-transplanted patients were examined with this assay; 75 of them could be observed from the date of transplantation. These 7 5 patients consisted of two groups: 59 kidney transplant patients rece iving no CMV hyperimmunoglobulin prophylaxis (group I), 13 heart-trans planted patients, and 3 liver transplanted patients receiving prophyla xis (group II). Group Ill consisted of 105 patients who had been trans planted ca. 2 years before starting this study. In group I, 26 (44%) w ere CMV-pp65-positive (13 primary and 13 secondary infections). Fiftee n of these 26 (58%) positive patients showed clinical symptoms of CMV infection. Eleven of these 15 (73%) were primary infections. Symptomat ic patients had significantly more CMV-pp65-positive cells than asympt omatic patients; 12 patients showed a high number of positive cells an d 11 of them developed severe CMV illness. Thirty-three patients were CMV-pp-65-negative (22 CMV IgG-seropositive, 11 CMV IgG-seronegative). None of them had symptoms of CMV infection. In all patients of group I there were 36 periods of graft dysfunction in which CMV infection ha d to be differentiated from transplant rejection. In 10 out of 36 ther e was a CMV-pp65-positive test result and subsequent seroconversion. T reatment of viral infection resulted in improvement of clinical proble ms. In the remaining 26 episodes no CMV-pp65-positive cells were detec ted: in 17 cases graft dysfunction was caused by rejection, in 9 cases by other complications. In group II, 13 of 16 patients (81%) were pos itive in the CMV-pp65 assay (6 primary infections, 7 secondary infecti ons). However, none of them showed clinical signs of CMV infection, re gardless of the number of positive cells. No CMV-related graft dysfunc tion was observed. In group III, CMV infections did not play an import ant role. The experiences described suggest that this test is a valuab le tool in early CMV diagnosis and in differentiating CMV-dependent gr aft dysfunction from other graft dysfunctions. It allows prompt therap eutic intervention.