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Journal of Clinical Microbiology, August 2002, p. 2945-2952, Vol. 40, No. 8
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.8.2945-2952.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

Monitoring of Viral Load by Quantitative Plasma PCR during Active Cytomegalovirus Infection of Individual Liver Transplant Patients

Heli Piiparinen,1* Krister Höckerstedt,2 Maija Lappalainen,1 Jukka Suni,1 and Irmeli Lautenschlager1

Departments of Virology,1 Surgery, Transplantation and Liver Surgery Unit, Helsinki University, and Helsinki University Central Hospital, Helsinki, Finland2

Received 28 December 2001/ Returned for modification 17 February 2002/ Accepted 12 May 2002

A quantitative PCR test, the Cobas Amplicor CMV Monitor, was used for the monitoring of viral load in the peripheral blood of 27 individual liver transplant patients and correlated with cytomegalovirus (CMV) pp65 antigenemia. Altogether, 243 specimens were analyzed. During the first 3 months, 20 patients showed PCR positivity which correlated with pp65 antigenemia. Of those, 13 patients developed symptomatic CMV infection 27 to 52 days after transplantation, with a significantly higher peak viral load in PCR and in pp65 assay compared with the seven asymptomatic infections (median 10,200 versus 2,240 copies/ml, P < 0.05, and median 100 versus 30 pp65-positive cells/50,000 leukocytes, P < 0.01). Five were primary infections of D+/R- cases (donor CMV seropositive and recipient seronegative) and demonstrated, except in one case, a high peak viral load (>10,000 copies/ml; range, 10,200 to 21,600 copies, and >=50 positive cells, range, 50 to 800 cells). The peak viral loads of the six D+/R+ patients with symptomatic infection varied widely (range, 2,290 to 126,000 copies and 50 to 300 positive cells). Two D-/R+ patients developed symptomatic infection with a lower viral load (range, 1,120 to 6,510 copies and 25 to 100 positive cells). All symptomatic infections were successfully treated with ganciclovir. The asymptomatic infections all in D+/R+ patients with low copy numbers (<5,500 copies) were monitored until CMV disappeared. One of the seven PCR-negative patients had one sample with low antigenemia, but the subsequent specimens were all negative. The time-related correlation of the two methods was also good. In summary, quantitative PCR could equally well be used as the CMV pp65 assay for the monitoring of viral load in individual transplant patients.

* Corresponding author. Mailing address: Department of Virology, Helsinki University Central Hospital, Haartmaninkatu 3, FIN-00290 Helsinki, Finland. Phone: 358-9-19126486. Fax: 358-9-19126491. E-mail: Heli.Piiparinen{at}helsinki.fi.

Journal of Clinical Microbiology, August 2002, p. 2945-2952, Vol. 40, No. 8
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.8.2945-2952.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.



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