Journal Article

CMV infection of the renal allograft is much more common than the pathology indicates: a retrospective analysis of qualitative and quantitative buffy coat CMV‐PCR, renal biopsy pathology and tissue CMV‐PCR

Helen Liapis, Gregory A. Storch, D. Ashley Hill, Jose Rueda and Daniel C. Brennan

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 18, issue 2, pages 397-402
Published in print February 2003 | ISSN: 0931-0509
Published online February 2003 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/18.2.397
CMV infection of the renal allograft is much more common than the pathology indicates: a retrospective analysis of qualitative and quantitative buffy coat CMV‐PCR, renal biopsy pathology and tissue CMV‐PCR

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Background. Quantitative blood polymerase chain reaction (PCR) for cytomegalovirus (CMV) is used to direct therapy in kidney transplant patients, but cytomegalic inclusions are rarely found in allograft renal biopsies even with an elevated serum creatinine and apparent CMV disease. The relationship between quantitative blood CMV and renal allograft pathology is unknown.

Methods. Thirteen biopsy samples were available for analysis from patients suspected of CMV disease, who had a buffy coat CMV‐PCR drawn within 2–5 days of a renal allograft biopsy for an elevated creatinine. All were evaluated for CMV pathologically, by light microscopy, immunohistochemistry, in situ hybridization and tissue PCR.

Results. Qualitative and quantitative buffy coat CMV‐PCR were positive in 10/13 (77%) patients. Tissue CMV‐PCR was positive in five (50%) biopsies, including two with CMV inclusions and three with no inclusions. Quantitative buffy coat CMV‐PCR levels did not correlate with detection of CMV inclusions in renal tissue. Paradoxically, quantitative buffy coat CMV‐PCR was low (239 and 538 copies/µg of DNA) when CMV inclusions were detected. All five biopsies with acute rejection were associated with CMV viraemia and two of the five with allograft CMV inclusions. A quantitative buffy coat CMV‐PCR of <100 copies/µg of DNA ruled out disease with CMV inclusions.

Conclusions. CMV nephropathy is much more common than previously reported when sensitive techniques are used for detection in tissue. Acute rejection and CMV viraemia occur commonly together in patients at risk for CMV. Quantitative buffy coat CMV‐PCR does not correlate with the presence of CMV inclusions. These findings have implications for management of patients who have elevated serum creatinine and are at risk for CMV disease.

Keywords: biopsy; blood; CMV‐PCR; histopathology; kidney; transplant

Journal Article.  3433 words.  Illustrated.

Subjects: Nephrology

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