The Role of The Cytomegalovirus Antigenemia Assay in the Detection and Prevention of Cytomegalovirus Syndrome and Disease in Solid Organ Transplant Recipients: A Review of the British Columbia Experience

Abstract

Based on performance characteristics, the Vancouver General Hospital's current method of antigenemia testing to guide pre-emptive ganciclovir therapy in SOT patients is not optimal for the early detection of disease. Further study is needed on new molecular testing methods to determine if our ability to predict CMV disease can be improved.

KHA‐CARI guideline: Cytomegalovirus disease and kidney transplantation

“…Antigen detection and qualitative PCR have enhanced sensitivity compared with culture techniques in the detection of infection and this also appears to be the case for quantitative PCR and the newer nucleic acid‐based techniques 1–5 …”

“…Serology should be used pretransplant to define cytomegalovirus (CMV) serological status and thereby stratify the risk of CMV infection post‐transplant 1 …”

Comparison of the performance of polymerase chain reaction and pp65 antigenemia for the detection of human cytomegalovirus in immunosuppressed patients

“…Human cytomegalovirus infection is a severe pathology and widely affects transplant patients 4,5,[11][12][13] . The concern with the worsening of a patient's health by cytomegalic disease is clearly revealed in the present sample, since of the total of 85 patients followed-up for HCMV viremia, 73 were transplant patients: 41 kidney, 24 bone marrow and 8 liver transplant patients.…”

“…Due to the use of a preemptive treatment strategy for HCMV in transplanted patients, there is a great demand for diagnostic methods that can determine viral replication prior to the manifestation of clinical symptoms. For this reason, diagnostic tests that have high sensitivity and NPV are fundamental for transplanted patients under immunosuppression 12 . In this study, the sensitivity and specificity of PCR were 87.5% and 76.8%, considering antigenemia as the gold standard.…”

“…Consequently PCR is specifically indicated for the initial diagnosis of HCMV infection. In the case of preemptive treatment strategy, identification of patients at high-risk of HCMV disease is fundamental 3,5,11,12 and PCR can be a useful tool in these cases.…”