Low predictive value of polymerase chain reaction for diagnosis of cytomegalovirus disease in liver transplant recipients

The polymerase chain reaction (PCR) and viral culture techniques were prospectively compared for the detection of cytomegalovirus (CMV) in blood samples from 24 liver transplant recipients. Nine patients had one or more episodes of viremia, seven of which were clinically symptomatic infections. All samples in which CMV was isolated by culture were positive by the PCR. However, the PCR result was also positive for one or more samples from 11 patients who never developed CMV-related symptoms. Although the PCR is a very sensitive technique for CMV detection in blood samples from liver transplant recipients, it is not useful as a marker of symptomatic CMV disease. Cytomegalovirus (CMV) is the single most frequent infec-tious agent in liver transplantation (11). In transplantation patients, CMV not only is a major cause of morbidity and mortality but also can be associated with an immunosuppres-sive state, superinfection by other opportunistic microorgan-isms, and allograft rejection (7). Viremia is a prominent feature of CMV infection and, unlike urinary or pharyngeal shedding, is frequently associated with clinical symptom