New molecular assays to predict occurrence of cytomegalovirus disease in renal transplant recipients

Thirty renal transplant recipients, after transplantation, were tested week ly with the following assays: cytomegalovirus (CMV) antigenemia (pp65 Ag), plasma qualitative Amplicor CMV (P-AMP), plasma and peripheral blood leukoc yte quantitative Amplicor CMV monitor (P- and PBL-CMM), peripheral blood le ukocyte (PBL) quantitative Quantiplex bDNA CMV, version 2.0 (bDNA), and who le-blood Nuclisens pp67 CMV (pp67). Eleven patients developed symptomatic C MV disease, and 7 developed asymptomatic CMV infection. For prediction of C MV disease, the sensitivity, specificity, and positive and negative predict ive values, respectively, were as follows: 100%, 63%, 61%, and 100% for pp6 5 Ag; 100%, 42%, 50%, and 100% for bDNA; 91%, 47%, 50%, and 90% for PBL-CMM ; 55%, 74%, 55%, and 74% for P-AMP; 55%, 74%, 55%, and 74% for P-CMM; and 6 4%, 79%, 64%, and 79% for pp67, First positive results in PBL were obtained 9-10 days before symptoms of CMV disease, compared with 5-6 days in plasma and 0 days in whole blood. PBL assays appear to be more appropriate than p lasma assays when pre-emptive therapy is required to prevent the rapid prog ression from the first detection of the virus to CMV disease.