CLINICAL-SIGNIFICANCE OF VIRAL LOAD IN THE DIAGNOSIS OF CYTOMEGALOVIRUS DISEASE AFTER LIVER-TRANSPLANTATION

In a cohort of 43 liver transplant recipients who did not receive anti viral prophylaxis, qualitative and quantitative polymerase chain react ions (PCRs) from peripheral blood were prospectively compared to deter mine their value in the diagnosis of established cytomegalovirus (CMV) disease and for the early detection of CMV replication as a marker fo r preemptive antiviral therapy, Using a cutoff of 7000 copies of CMV D NA per sample, the specificity and positive predictive values of quali tative PCR for the diagnosis of established CMV disease increased from 33% to 89% and from 54% to 82%, respectively, without reducing the 10 0% sensitivity and negative predictive value. By contrast, quantificat ion of viral load provided no additional advantage to qualitative PCR for the early diagnosis of CMV infection before development of disease .