Surveillance serology for the monitoring of CMV disease in lung transplant recipients

Luis F. Angel, E. Y. Sako, I. Susanto, A. Anzueto, S. M. Levine, J. I. Peters, S. G. Jenkinson, C. L. Bryan

Research output: Contribution to journalArticle

Abstract

Purpose: Cytomegalovirus (CMV) infection remains the most common opportunistic infection after lung transplantation. The reported incidence has approached 70%, and CMV pneumonitis is documented in 10 to 15% of infected patients. We studied 88 consecutive lung transplants at the University of Texas Health Science Center that survived more than 1 month and assessed the value of serology in predicting CMV infection and disease. Methods: The preoperative CMV status was defined by CMV IgG by ELISA. CMV serologic matching between the donor lung (D) and recipient (R) were as follows: 64 R+/D+or-, 5 R-/D+ and 16 R-/D+. Serologic identification was made postoperatively in patients whose serum had a baseline CMV antibody titer <8 with subsequent > fourfold rise or a positive CMV specific IgM. CMV infection was defined by identification of the virus in a body fluid without evidence of tissue injury (positive culture, shell vial assay or CMV antigen in urine, throat wash, blood buffy coat, or bronchoalveolar lavage fluid) CMV disease was defined by the presence of typical CMV cells with inclusions or positive immunohistochemical staining of lung tissue with or without symptoms. One patient with a typical syndrome of CMV pneumonitis who did not undergo bronchoscopy was included. CMV infection was documented in 64 patients (75%) and CMV disease in 19 patients (22%). Results: Serology Serology vs. Infection vs. Disease Sensitivity 44% 36% Specificity 91% 65% Positive pred value 93% 22% Negative pred value 36% 78% Conclusions: Most patients with positive serology demonstrated evidence of CMV infection by shell vial or culture. However, many patients with negative serology still demonstrated evidence of CMV infection. Ignoring shell vials, 21% of all serologically CMV negative patients and 22% of all seropositive patients developed CMV disease. These data suggest that negative serology does not predict a CMV susceptible state and newly positive serology does not predict inevitable tissue destruction by the virus. Clinical Implications: CMV serology is superfluous in programs that routinely monitor body fluids with CMV shell vials and culture.

Original languageEnglish (US)
Pages (from-to)222S
JournalChest
Volume110
Issue number4 SUPPL.
StatePublished - Oct 1 1996

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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