PREDICTIVE VALUE OF CYTOMEGALOVIRUS DNA DETECTION BY POLYMERASE CHAIN-REACTION IN BLOOD AND BRONCHOALVEOLAR LAVAGE IN LUNG-TRANSPLANT PATIENTS

Background. Despite promising results, the efficacy of polymerase chai n reaction (PCR) for clinical management of cytomegalovirus (CMV) infe ction in transplanted patients is still controversial. Methods. A pros pective study of CMV detection, with concurrent shell vial cultures an d PCR in blood and bronchoalveolar lavage (BAL), was conducted in 13 l ung transplant recipients, monitored for 15 months (range: 1-42 months ). CMV DNA was detected by PCR amplification of a 406-bp fragment in t he Us region and a 290-bp fragment in the immediate early region of th e viral genome. Results. When comparing PCR to viral culture, the sens itivity and specificity of CMV DNA detection were 100% and 65.7% in bl ood (n=122) and 100% and 75% in BAL, (n=104). The positive and negativ e predictive values of PCR for a forthcoming diagnosis of CMV infectio n were 50% and 97% in blood, and 67% and 85% in BAL. Seventeen CMV inf ections were evaluated at the end of treatment: when PCR was still pos itive either in blood or BAL, CMV infection relapsed within 35 +/- 5 d ays; when PCR was negative, CMV infection relapsed after 142 +/- 57 da ys (P=0.01). Conclusions. Negative CMV detection by PCR strongly advoc ates against a forthcoming CMV infection, PCR assay seems to be a good predictor for early recurrence of CMV infection, and would be useful for monitoring the response to antiviral therapy.