Quantity of human cytomegalovirus (CMV) DNAemia as a risk factor for CMV disease in renal allograft recipients: Relationship with donor/recipient CMVserostatus, receipt of augmented methylprednisolone and antithymocyte globulin (ATG)

A prospective longitudinal study of 87 renal allograft recipients identifie d 31 patients with cytomegalovirus (CMV) viraemia. Previous studies have id entified CMV viraemia, donor positivity, and CMV load in urine as independe nt risk factors for disease following renal transplantation. We used quanti tative-competitive polymerase chain reaction (OC-PCR) to quantify the CMV D NA load in blood from these patients, and report that it is a significant a nd independent risk factor for CMV disease. Patients with symptomatic CMV i nfection had significantly higher maximum CMV loads than those with no dise ase (P = .0003). We also found that peak loads were significantly higher in individuals experiencing primary CMV infection (P < .01), and CMV re-infec tion (P < .05) compared with recipients reactivating endogenous CMV. Univar iate analysis revealed that CMV DNA load in blood, donor seropositivity, an d receipt of antithymocyte globulin (ATG) were all significantly associated with disease (P = .005, .04, and .05, respectively). However, the associat ion of donor/recipient serostatus, and receipt of ATG became nonsignificant in multivariate analyses whereas the significance of the quantity of CMV D NAemia was maintained, illustrating that CMV load plays a central role in t he pathogenesis of CMV disease. J. Med. Virol. 58:182-187, 1999, (C) 1999 W iley-Liss, Inc.