SURVEILLANCE CULTURES OF BLOOD, URINE, AND THROAT SPECIMENS ARE NOT VALUABLE FOR PREDICTING CYTOMEGALOVIRUS DISEASE IN LIVER-TRANSPLANT RECIPIENTS

The role of markers of cytomegalovirus (CMV) infection, such as the is olation of CMV, the presence of CMV antigenemia, or detection of viral DNA by polymerase chain reaction (PCR) assay, as predictors of subseq uent CMV disease has been examined in recent studies. We studied the v alue of performing surveillance cultures of blood, urine,and throat sp ecimens in a cohort of 156 liver transplant recipients who had partici pated in clinical trials and had received ganciclovir only far documen ted CMV disease. Cultures of urine and throat specimens far detection of CMV were performed every week, and cultures of blood specimens were performed every other week for the first 2 months after transplantati on, then monthly for 6 months. Eighty-nine (57%) of 156 patients devel oped CMV infection, 41 (46%) of whom developed clinical CMV disease (3 6 had organ involvement and five had CMV syndrome). Fifty (32%) of 156 patients had positive blood cultures, 35 (22%) had positive urine cul tures, and 41 (26%) had positive throat cultures. The positive and neg ative predictive values of surveillance cultures for predicting CMV di sease were as follows: blood cultures, 46% and 83%, respectively; urin e cultures, 26% and 74%, respectively; and throat cultures, 32% and 76 %, respectively. These data indicate that such cultures are not useful in predicting CMV disease in Liver transplant recipients. Future stud ies should examine the value of alternative markers, such as CMV antig enemia or the detection of viral DNA by PCR, for predicting CMV diseas e in this setting.