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Quantitative Polymerase Chain Reaction to Predict Occurrence of Symptomatic Cytomegalovirus Infection and Assess Response to Ganciclovir Therapy in Renal Transplant Recipients

Thomas C. Roberts, Daniel C. Brennan, Richard S. Buller, Monique Gaudreault-Keener, Mark A. Schnitzler, Kara E. Sternhell, Kathryn A. Garlock, Gary G. Singer and Gregory A. Storch
The Journal of Infectious Diseases
Vol. 178, No. 3 (Sep., 1998), pp. 626-635
Published by: Oxford University Press
Stable URL: http://www.jstor.org/stable/30114314
Page Count: 10
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Quantitative Polymerase Chain Reaction to Predict Occurrence of Symptomatic Cytomegalovirus Infection and Assess Response to Ganciclovir Therapy in Renal Transplant Recipients
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Abstract

Cytomegalovirus (CMV) DNA levels were measured by quantitative-competitive polymerase chain reaction (PCR) in weekly leukocyte samples from 50 renal transplant recipients, including 23 with symptomatic and 27 with asymptomatic CMV infection. Peak and week 4 CMV DNA levels were higher in symptomatic subjects (P = .07 and .02, respectively). In a logistic regression model, the logarithm of the week 4 level independently predicted symptomatic infection (odds ratio, 1.78 for a 1 logio increase; 95*26 confidence interval, 1.14-2.78; P = .01). All subjects whose week 4 level exceeded 1000 copies/100,000 leukocytes developed symptoms. In subjects with adequate samples for analysis, CMV levels declined exponentially with ganciclovir treatment, with an average halflife of 3.3 days. Levels exceeding 10,000 copies were associated with prolonged time to clearing of CMV DNA. Potential clinical applications of quantitative CMV PCR include predicting occurrence of symptomatic first episodes after transplantation and individualizing duration of antiviral therapy.

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