Clinical Utility of Cytomegalovirus Viral Load Testing for Predicting CMV Disease in D+/R- Solid Organ Transplant Recipients

Atul Humar, Carlos Paya, Mark D. Pescovitz, Ed Dominguez, Kenneth Washburn, Emily Blumberg, Barbara Alexander, Richard Freeman, Nigel Heaton, Barbara Mueller

Research output: Contribution to journalArticlepeer-review

89 Scopus citations

Abstract

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 preemptive 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.

Original languageEnglish (US)
Pages (from-to)644-649
Number of pages6
JournalAmerican Journal of Transplantation
Volume4
Issue number4
DOIs
StatePublished - Apr 2004

Keywords

  • Cytomegalovirus
  • Ganciclovir
  • Solid organ transplant
  • Valganciclovir
  • Viral load

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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