A PROSPECTIVE-STUDY OF THE PREDICTIVE VALUE OF POLYMERASE-CHAIN-REACTION ASSAY FOR CYTOMEGALOVIRUS IN ASYMPTOMATIC KIDNEY-TRANSPLANT RECIPIENTS

Cytomegalovirus (CMV) infection carries the potential for high morbidi ty in transplant recipients. The institution of pre-emptive therapy pr ior to the onset of clinical disease on the basis of CMV-polymerase ch ain reaction (PCR) is very attractive. We prospectively studied 52 asy mptomatic kidney transplant recipients to test the hypothesis that ser ial CMV-PCR assays during the first 3 months post-transplant would ide ntify patients at risk for CMV disease. Twenty-three patients (44.2%) had positive CMV-PCR tests at least once; 2 (8.6%) developed CMV. None of the 29 patients continuously negative for CMV-PCR developed CMV di sease. CMV-PCR status did not influence patient and graft survival or the incidence of acute rejection. We conclude that while a substantial number of kidney transplant recipients become positive for CMV-PCR in the early post-transplant period, only a minority will develop CMV di sease. Negative CMV-PCR assay is an accurate negative predictor for CM V disease but the value of CMV-PCR as a guide for pre-emptive anti-CMV therapy in kidney transplant recipients appears limited.