Abstract
BackgroundCMV is a major clinical problem in transplant recipients. Thus, it is important to use sensitive and specific diagnostic techniques to rapidly and accurately detect CMV infection and identify patients at risk of developing CMV disease. In the present study, CMV infection after liver transplantation was monitored retrospectively by two molecular biology assays - a quantitative PCR assay and a qualitative NASBA assay. The results were compared with those obtained by prospective pp65 antigenemia determinations.Materials and Methods87 consecutive samples from 10 liver transplanted patients were tested for CMV by pp65 antigenemia, and CMV monitor and NASBA pp67 mRNA assay.ResultsCMV infection was detected in all patients by antigenemia and CMV monitor, whereas NASBA assay identified only 8/10 patients with viremia. Furthermore, CMV infection was never detected earlier by molecular biology assays than by antigenemia. Only 5/10 patients with CMV infection developed CMV disease. Using a cut off value of 8 cells/50,000, antigenemia was found to be the assay that better identified patients at risk of developing CMV disease. However, the kinetics of the onset of infection detected by NASBA and CMV monitor seemed to have better identified patients at risk of developing CMV disease. Furthermore, before onset of disease, CMV pp67 mRNA was found to have similar or better negative and positive predictive values for the development of CMV disease.ConclusionsThe present data, suggests that the concomitant use of antigenemia and pp67 mRNA assay gives the best identification of patients at risk of developing CMV disease.
Highlights
CMV is a major clinical problem in transplant recipients
The present data, suggests that the concomitant use of antigenemia and pp67 mRNA assay gives the best identification of patients at risk of developing CMV disease
In patients with defective immunity, as recipients of allogeneic solid organ (SOT), bone marrow transplants (BMT) and individuals infected with HIV, CMV remains a major clinical problem [1,2]
Summary
CMV is a major clinical problem in transplant recipients. it is important to use sensitive and specific diagnostic techniques to rapidly and accurately detect CMV infection and identify patients at risk of developing CMV disease. In patients with defective immunity, as recipients of allogeneic solid organ (SOT), bone marrow transplants (BMT) and individuals infected with HIV, CMV remains a major clinical problem [1,2]. For this reason, diagnostic methods that rapidly and unequivocally identify emerging CMV biologic activity (i.e. replication, viral gene expression), preferably discriminating between subclinical and symptomatic infection are rehttp://www.biomedcentral.com/1471-2334/1/2 quired for optimal surveillance and management of CMV infections. The detection of mRNA for the viral matrix tegument pp protein in blood leukocytes reflects viral transcriptional activity and has been showed to be a specific assay for monitoring the onset of symptomatic CMV infection and antiviral therapy [15,16,17]
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