RELATIONSHIP OF THE POLYMERASE CHAIN-REACTION FOR CYTOMEGALOVIRUS TO THE DEVELOPMENT OF HEPATITIS IN LIVER-TRANSPLANT RECIPIENTS

In a pilot study, the polymerase chain reaction was found to be more s ensitive than standard viral culture methods for the detection of cyto megalovirus, particularly from blood and tissues. We therefore applied this technique to 71 serially collected liver biopsies from 16 orthot opic liver transplant patients. All patients were CMV-seropositive (n= 15) or seroconverted (n=1). Seven patients (9 biopsies) had histologic ally proved CMV hepatitis, and all these biopsies were CMV PCR-positiv e. Six of these 7 patients had a prior liver biopsy that was CMV PCR-p ositive, but culture and histology-negative, an average of 13.2+/-6.9 days before the histologically positive biopsy. The 7th patient was no t biopsied prior to the diagnostic biopsy. Three patients had 7 liver biopsies that were CMV PCR-positive, but histologically negative for C MV hepatitis. Two of these three had CMV infection confirmed by viral culture of blood or liver biopsy. The remaining 6 patients had a total of 26 liver biopsies that were negative for CMV by PCR, culture, and histology. Among liver transplant patients, CMV PCR performed on liver biopsy specimens correctly identified all histologically proven cases of CMV hepatitis. CMV PCR positivity in liver tissue did not correlat e with latent infection and preceded the development of CMV hepatitis or other meaningful CMV infection in 8 of 10 patients.