THE DIAGNOSIS OF CMV PNEUMONITIS IN LUNG AND HEART-LUNG TRANSPLANT PATIENTS BY PCR COMPARED WITH TRADITIONAL LABORATORY CRITERIA

Polymerase chain reaction (PCR) amplification of CMV DNA recovered fro m bronchial alveolar lavage (BAL) and peripheral blood samples was com pared with tissue culture, cytology, and/or histology for the earlier detection of CMV pneumonitis in 12 recipients of single-lung or heart/ lung transplants. In patients with confirmed CMV pneumonitis, cytologi cal evidence of CMV disease in BAL samples was detected 38+/-14 days p ost-transplantation, while tissue culture and PCR-positive results wer e noted as early as 30+/-4.0 days and 18+/-4.6 days, respectively. Whi le PCR was positive earlier than culture in a number of cases, culture -positive results were subsequently obtained in each case, consistent with earlier detection of viral replication by PCR as opposed to detec tion of latent virus. CMV was detected by PCR in 6 of 24 blood samples from patients with confirmed or suspected CMV pneumonitis, while resu lts of all 24 blood samples were negative when assayed by tissue cultu re. PCR-based testing was more sensitive than traditional tests, allow ing detection of viral replication earlier than tissue culture in the posttransplant period. PCR could provide a powerful means of monitorin g the immunocompromised patients in whom preemptive therapeutic interv ention for CMV disease is desirable.