The clinical value of an in-house cytomegalovirus nested polymerase chain reaction (CMV-PCR) and a commercial molecular assay hybrid capture CMV DNA assay (HCA) was evaluated in monitoring a group of renal transplant patients for six months follow up. In this study, the sensitivity, specificity, positive predictive value, and negative predictive value of nested CMV DNA PCR assay and HCA at the beginning of the study were 70, 42.9, 46.7, 66.7, and 60, 78.6, 66.7, and 73.3% respectively. After six months, they were 80, 66.7, 80, 66.7 for CMV PCR and 73.3, 88.9, 91.7, 66.7% Human cytomegalovirus (CMV) infection is responsible for significant mortality and morbidity and graft failure in renal transplant recipients (Tong et al. 1998). The early identification of CMV is important as the majority of patients develop infection and the best result is obtained when treatment is started earlier (Rubin & Tolkoff-Rubin 1993). CMV must be detected before clinical symptom appearance, but virus detection is not always followed by CMV disease (Eckart et al. 1997). Laboratory diagnosis of CMV infection is based primarily on the detection of CMV viremia and active CMV infection after the onset of symptoms. By means of advanced laboratory assays, it is possible to have positive laboratory assay results before the onset of symptoms. However, laboratory diagnosis of active CMV infection is not always associated with symptomatic disease (Tong et al. 1998) and the identification of these patients for clinically relevant disease is difficult.Various qualitative and quantitative molecular assays are used to monitor renal transplant recipients and they appear to be more convenient and sensitive than the traditional methods such as serology, virus cultures and shell vial assays. The detection CMV DNA in leukocytes or plasma by polymerase chain reaction (PCR) is the most sensitive method of identifying CMV disease. However a highly sensitive CMV-PCR may detect latent virus that is not involved in disease (Rollag et al. 1998). The commonly used DNA hybridization assays offer the advantage of objective CMV DNA detection and quantification without the hazards of PCR such as contamination or inhibition (Aitken et al. 1999). The aim of this study was to monitor a group of adult Turkish renal transplant patients for six months follow up by using PCR and hybrid capture CMV DNA assay (HCA) in detecting and predicting CMV disease and to evaluate the relationship between the CMV-DNA presence and the symptomatic human CMV infection. As far as we are concerned this is the first follow up study in renal transplant patients using molecular assays in Turkey.
MATERIALS AND METHODSPatients and specimens -Blood samples were obtained from 24 kidney transplant recipients who were CMV IgG positive. EDTA-anticoagulated blood samples were collected at monthly intervals during six months. All of the blood samples were evaluated with both PCR and HCA at the beginning of this follow up study and after six months. In the same way, the clinical symptoms of the pat...