In general, higher CMV viral loads are associated with tissue-invasive disease, while lower levels are associated with asymptomatic infection. A number of factors can affect CMV viral load results, including the specimen type (whole blood versus plasma), biologic properties of CMV, performance characteristics of the quantitative assay (eg, limit of detection, limits of quantification, linearity, and reproducibility), degree of immunosuppression, and intensity of antiviral therapy. In addition, quantification of CMV DNA level in peripheral blood (ie, CMV viral load) is used routinely to determine when to initiate preemptive antiviral therapy, diagnose active CMV disease, and monitor response to antiviral therapy. Lung, heart, small intestine, pancreas, and kidney-pancreas transplant recipients are at greater risk for CMV infection than kidney and liver transplant recipients.Īmong the various clinical laboratory diagnostic tests currently available to detect CMV infection, nucleic acid amplification tests (eg, polymerase chain reaction: PCR) are the most sensitive and specific detection methods. Factors, such as the type of organ transplanted, intensity of the antirejection immunosuppressive therapy, advanced age, and presence of comorbidities in the recipient, are also associated with increased risk for CMV disease after allograft transplantation. CMV disease may also occur from reactivation of the virus already present within the recipients. The infection is transmitted via latent CMV present in the transplanted organ donor and the virus subsequently reactivates, causing a primary CMV infection in the recipient. The risk of CMV disease is highest among organ recipients who are CMV seronegative prior to transplantation and receive allografts from CMV-seropositive donors (ie, CMV D+/R- mismatch). Other manifestations of CMV infection in this population may be more subtle and include allograft injury and loss, increased susceptibility to infections with other organisms, and decreased patient survival (ie, indirect effects). Such infection usually manifests as fever, leukopenia, hepatitis, colitis, or retinitis. CMV infection and disease typically occur during the first year after organ transplantation after cessation of antiviral prophylaxis. Cytomegalovirus (CMV) is a common and major cause of opportunistic infection in organ transplant recipients, causing significant morbidity and mortality.

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