Premium
Clinical Utility of Cytomegalovirus Viral Load Testing for Predicting CMV Disease in D+/R‐ Solid Organ Transplant Recipients
Author(s) -
Humar Atul,
Paya Carlos,
Pescovitz Mark D.,
Dominguez Ed,
Washburn Kenneth,
Blumberg Emily,
Alexander Barbara,
Freeman Richard,
Heaton Nigel,
Mueller Barbara
Publication year - 2004
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2004.00391.x
Subject(s) - medicine , cytomegalovirus , cytomegalovirus infection , viral load , solid organ , organ transplantation , immunology , virology , transplantation , human cytomegalovirus , viral disease , herpesviridae , virus
Despite prophylaxis, cytomegalovirus (CMV) disease is common in donor seropositive (D+)/recipient seronegative (R‐) transplant patients after cessation of prophylaxis. Early detection of CMV may allow for pre‐emptive therapy to prevent active disease. The clinical utility of quantitative plasma viral load measurements for predicting CMV disease was determined in 364 D+/R‐ organ transplant patients receiving prophylaxis (100 d of valganciclovir or oral ganciclovir). Measurements were performed every 2 weeks until day 100 and at months 4, 4.5, 5, 6, 8 and 12 post‐transplant. CMV disease occurred in 64 (17.6%) patients by 12 months. Using a positive cut‐off value of > 400 copies/mL, sensitivity was 38%, specificity 60%, positive predictive value 17%, and negative predictive value 82% for prediction of CMV disease. Therefore, routine monitoring would have predicted disease in only 24/64 (38%) patients. The test characteristics were not improved by changing the viral load cut‐off point for defining a positive result. Similarly, single time point measures at the end of prophylaxis or month 4 had low sensitivity for disease prediction. Overall, regular CMV plasma viral load measurements were only of modest value in predicting CMV disease.