Evaluation of diagnostic tests for cytomegalovirus active infection in renal
            transplant recipients

Franco, Rodrigo Fontanive; Montenegro, Rosangela Munhoz; Machado, Alice Beatriz Mombach Pinheiro; Paris, Fernanda de; Menezes, Denise da Silva; Manfro, Roberto Ceratti

doi:10.5935/0101-2800.20170008

Cited by 9 publications

(11 citation statements)

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“…Previous retrospective studies have described other risk factors for CMV recurrence such as D+/R− serostatus, acute rejection treatment, and diabetes mellitus, which were not found in our study. Nevertheless, we observed a higher relapse rate in patients with primary CMV infection compared to those with recurrent infection.…”

Section: Discussioncontrasting

confidence: 79%

Reduction in mortality associated with secondary cytomegalovirus prophylaxis after solid organ transplantation

Alonso

Guillén-Grima

Martín-Moreno

et al. 2018

Transplant Infectious Dis

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Section: Discussioncontrasting

confidence: 79%

Reduction in mortality associated with secondary cytomegalovirus prophylaxis after solid organ transplantation

Alonso

Guillén-Grima

Martín-Moreno

et al. 2018

Transplant Infectious Dis

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“…The evaluation of the correlation between the two diagnostic methods showed that they have a good correlation. This is in agreement with previous comparisons between pp65 antigenemia and PCR for the diagnosis of active CMV infection [33][34][35][36][37].…”

Section: Discussionsupporting

confidence: 93%

Molecular Study of Cytomegalovirus Infection among Children with End Stage Renal Diseases Undergoing Dialysis, Pilot Study

2017

Medical &Amp; Clinical Research

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Cytomegalovirus is considered as an opportunistic infection affecting immunocompromized patients. Children with end stage renal diseases requiring dialysis is among affected population by this virus. The aim of the present study was to detect and compare the seroprevalence of CMV and CMV antigen pp65 with real time polymerase chain reaction (PCR) among children with end stage renal diseases undergoing dialysis. The study is a prospective case - control study. The forty one patients included in the studied are registered in the hospital for regular dialysis waiting for renal transplantation. The study included forty one healthy controls with same age and gender distribution. Blood samples were obtained from studied children and subjected for determination of specific immunoglobulin M and G for CMV (IgM-CMV, IgG-CMV) by Elecys system and CMV-DNA determination by real time polymerase chain reaction (PCR) and for PP65 antigenaemia test by light diagnostic CMVpp65. CMV-IgM was significantly detected frequently (P=0.0001) in 12.2% of the patients and in 2.4% of the control children. Moreover, IgG-CMV was significantly more frequently detected in patients (P=0.0001) than in control (90.2%&31.7% respectively). CMV-DNA was significantly (P=0.0001) detected in 12 patients (29.3%) compared to the control (2.4%), while CMVpp65 was detected among 4 children (9.8%) compared to one child in the control group. The comparison between IgM-CMV and real time PCR revealed that 30.7% of positive samples by PCR had positive IgMCMV, while IgG-CMV was associated with 84.6% of positive PCR. CMVpp65 correctly identified all negative samples compared to PCR, while the majority of negative PCR was also negative for IgM-CMV (98.6%). Moreover, all negative children for CMVpp65 was also negative by PCR (100%) For the validity of different CMV markers, IgG-CMV was the most sensitive test (84.7%), CMVpp65 was the most specific test 100%. From this study we concluded that CMV is a common viral infection among children with end stage renal diseases requiring dialysis. The diagnostic performance of real time PCR is the gold standard technique in diagnosis of this infection. CMVpp65 antigenemia is a specific accurate test for laboratory diagnosis however, it lacks sensitivity. Specific IgG for CMV is good screening diagnostic test.

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“…The incidence rates found in Brazil are similar to studies in Japan (70.8%) 16 and India (73.7%) 17 but differ from countries such as Korea, where the literature shows rates of 30-40% [18][19][20][21] , Finland of 27% 22 and in the USA, in a pediatric kidney transplant population, a rate of 27% was found. 23 The comparison between the two diagnostic tests performed in this study showed a concordance between the results of 70.3%, in agreement with previous studies that demonstrated concordances ranging from 66.6-94.3% 11,15,[18][19][20][23][24][25] . However, most of these studies were performed before the advent of the WHOIS, as well as before the knowledge of factors related to the presentation of the virus in different biological matrices 5,26,27 .…”

Section: Discussionsupporting

confidence: 92%

“…Considering the patients in this study with positive qPCR results who had negative performed in the same institution in 2004 using CMV antigenemia as a diagnostic tool observed 60.0% of infection and 38.4% of disease 10 . In a study carried out in another hospital in the same city in Brazil, with a composition of patients that was similar to that of this study, the incidence of CMV infection was 53.3% 11 . This cohort was characterized by an elevated seroprevalence of CMV infection in both donors and recipients, and by a limited proportion of patients on universal anti-CMV prophylaxis (16.6% of patients in comparison to 50.0% in the study by Franco et al (2017) 11,12,13 .…”

Section: Discussionsupporting

confidence: 74%

Clinical validation of an in-house quantitative real time PCR assay for cytomegalovirus infection using the 1st WHO International Standard in kidney transplant patients

et al. 2021

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Introduction: Cytomegalovirus (CMV) is one of the most common agents of infection in solid organ transplant patients, with significant morbidity and mortality. Objective: This study aimed to establish a threshold for initiation of preemptive treatment. In addition, the study compared the performance of antigenemia with qPCR results. Study design: This was a prospective cohort study conducted in 2017 in a single kidney transplant center in Brazil. Clinical validation was performed by comparing in-house qPCR results, against standard of care at that time (Pp65 CMV Antigenemia). ROC curve analysis was performed to determine the ideal threshold for initiation of preemptive therapy based on the qPCR test results. Results: Two hundred and thirty two samples from 30 patients were tested with both antigenemia and qPCR, from which 163 (70.26%) were concordant (Kappa coefficient: 0.435, p<0.001; Spearman correlation: 0.663). PCR allowed for early diagnoses. The median number of days for the first positive result was 50 (range, 24-105) for antigenemia and 42 (range, 24-74) for qPCR (p<0.001). ROC curve analysis revealed that at a threshold of 3,430 IU/mL (Log 3.54), qPCR had a sensitivity of 97.06% and a specificity of 74.24% (AUC 0.92617 ± 0.0185, p<0.001), in the prediction of 10 cells/105 leukocytes by antigenemia and physician's decision to treat. Conclusions: CMV Pp65 antigenemia and CMV qPCR showed fair agreement and a moderate correlation in this study. The in-house qPCR was revealed to be an accurate method to determine CMV DNAemia in kidney transplant patients, resulting in positive results weeks before antigenemia.

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Evaluation of diagnostic tests for cytomegalovirus active infection in renal transplant recipients

Abstract: Our data demonstrate that both methods are suitable and have almost equivalent accuracy for the detection of post-transplant cytomegalovirus replication. The choice for either test must take in consideration the demand, execution capability and cost-effectiveness at each institution.

Cited by 9 publications

References 0 publications

Reduction in mortality associated with secondary cytomegalovirus prophylaxis after solid organ transplantation

Reduction in mortality associated with secondary cytomegalovirus prophylaxis after solid organ transplantation

Molecular Study of Cytomegalovirus Infection among Children with End Stage Renal Diseases Undergoing Dialysis, Pilot Study

Clinical validation of an in-house quantitative real time PCR assay for cytomegalovirus infection using the 1st WHO International Standard in kidney transplant patients

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