Title : Laboratory diagnostics of CMV in the prediction of CMV disease in kidney transplant patients
Abstract:
Introduction: Human cytomegalovirus (CMV) infection causes life-threatening complications in immunocompromised transplant patients. It can lead to graft rejection; therefore, molecular follow-up of patients to predict the disease burden is crucial for timely and appropriate management and risk control. Here, we present the laboratory results of CMV testing in a selected group of 48 kidney transplant recipients suspected of developing CMV disease.
Methods: Patient serum was tested using qualitative and quantitative molecular methods for CMV DNA, along with chemiluminescent and immunofluorescent techniques to detect anti-CMV antibodies (IgM and IgG), in order to identify primary or secondary CMV infection.
Results: 14 (29.2%) of 48 suspected patients tested positive for CMV DNA. The CMV DNA levels ranged from <293 to 77,000 copies/mL, with most cases exhibiting clinical features of CMV disease. Only two patients with DNA copy numbers above 300/mL (450 and 330) did not develop clinical symptoms of CMV disease. None of the CMV DNA-positive renal transplant recipients who were followed up and tested for anti-CMV IgM was confirmed to be positive.
Conclusion: The absence of CMV disease in a patient with detectable CMV DNA indicates that there is still no consensus on the exact cut-off value for risk assessment or for defining CMV disease severity. The absence of CMV IgM in the presence of CMV DNA further indicates that serology is less reliable than molecular testing, as immunosuppression can affect normal antibody production and immune responses.
Keywords: CMV DNA, CMV disease, risk assessment.
