Laboratory Tests to Monitor CMV Infection in Transplant Patients

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Laboratory Tests to Monitor CMV Infection in Transplant Patients

Paolo Antonio Grossi
Infectious Diseases Department, University of Insubria, Varese, Italy

Human cytomegalovirus (CMV) was the first "opportunistic" virus described in renal transplant recipients under azathioprine and prednisone. It has been the most frequent cause of infectious complications after organ transplantation with all subsequent immunosuppressive regimens.

Antiviral prophylaxis for 90–100 days has documented beneficial effects and cost advantages; however, its efficacy is hampered by the selection of resistant strains and by the occurrence of late CMV disease in about 30% of CMV D+/R- patients.

In the recent years "preemptive therapy", as a strategy to reduce the incidence of CMV disease, has been adopted by many transplant centers in Europe and USA. An accurate detection method to identify patients at risk for developing CMV disease is an essential component of this strategy.

In the last decade several methods have been developed to detect and quantitate virus or viral components in blood of immunocompromised patients with CMV infection. Currently quantitative pp65 antigenemia in peripheral blood leukocytes (PBL) and leukoDNAemia or plasmaDNAemia in PBL or plasma, respectively, by quantitative PCR or hybridization methods, are the most widely adopted diagnostic techniques.

In addition, the severity of HCMV infection and the extent of organ involvement inversely correlate with the development or the restoration of an efficient CD4+ and CD8+ T-cell immune response. Simultaneous monitoring of HCMV infection and HCMV-specific T-cell immunity predicts T-cell-mediated control of HCMV infection and may be used for timely initiation of pre-emptive antiviral therapy.

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Last Updated : 04/12/2007 12:27:43