RELATION BETWEEN POLYMERASE CHAIN-REACTION FINDINGS AND MORPHOLOGICAL-CHANGES DURING CYTOMEGALOVIRUS-INFECTION IN TRANSPLANTED LUNG

Cytomegalovirus (CMV) can be present as a latent or productive infecti on resulting in disease. The polymerase chain reaction (PCR) is a sens itive technique to document the presence of CMV(DNA). Negative reactio ns are indicative of its absence. The presence of CMV (DNA) was assess ed longitudinally in 261 transbronchial lung biopsy (TBB) specimens fr om 37 patients over a 6-month period. The TBB specimens from six serol ogically CMV-negative recipients who received lungs from serologically CMV-negative donors never showed a positive CMV-PCR(DNA) reaction dur ing the study. Based on a study of their TBB specimens, 10 serological ly CMV-positive recipients who received lungs from serologically CMV-n egative donors all developed a CMV-PCR(DNA)-positive reaction and five (50%) morphologically manifested CMV disease. The remaining 21 serolo gically CMV-positive recipients who received lungs from serologically CMV-positive donors all developed a CMV-PCR(DNA)-positive reaction and 15 (71%) developed CMV pneumonitis. The data show that development of a positive CMV-PCR(DNA) reaction in a TBB sample within the first mon th after transplantation indicates a greatly increased risk of develop ing CMV disease. In addition, a positive CMV-PCR(DNA) reaction precede d morphologically manifest disease on average by 2 weeks. Comparisons between TBB and bronchoalveolar lavage show the former to provide a mo re dependable template.