CMV infection of the renal allograft is much more common than the pathology indicates

A retrospective analysis of qualitative and quantitative buffy coat CMV-PCR, renal biopsy pathology and tissue CMV-PCR

Helen Liapis, Gregory A. Storch, D. Ashley Hill, Jose Rueda, Daniel C. Brennan

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Background. Quantitative blood polymerase chain reaction (PCR) for cytomegalovirus (CMV) is used to direct therapy in kidney transplant patients, but cytomegalic inclusions are rarely found in allograft renal biopsies even with an elevated serum creatinine and apparent CMV disease. The relationship between quantitative blood CMV and renal allograft pathology is unknown. Methods. Thirteen biopsy samples were available for analysis from patients suspected of CMV disease, who had a buffy coat CMV-PCR drawn within 2-5 days of a renal allograft biopsy for an elevated creatinine. All were evaluated for CMV pathologically, by light microscopy, immunohistochemistry, in situ hybridization and tissue PCR. Results. Qualitative and quantitative buffy coat CMV-PCR were positive in 10/13 (77%) patients. Tissue CMV-PCR was positive in five (50%) biopsies, including two with CMV inclusions and three with no inclusions. Quantitative buffy coat CMV-PCR levels did not correlate with detection of CMV inclusions in renal tissue. Paradoxically, quantitative buffy coat CMV-PCR was low (239 and 538 copies/μg of DNA) when CMV inclusions were detected. All five biopsies with acute rejection were associated with CMV viraemia and two of the five with allograft CMV inclusions. A quantitative buffy coat CMV-PCR of

Original languageEnglish (US)
Pages (from-to)397-402
Number of pages6
JournalNephrology Dialysis Transplantation
Volume18
Issue number2
DOIs
StatePublished - Feb 1 2003
Externally publishedYes

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Cytomegalovirus Infections
Cytomegalovirus
Allografts
Pathology
Kidney
Biopsy
Polymerase Chain Reaction
Creatinine
Viremia
In Situ Hybridization

Keywords

  • Biopsy
  • Blood
  • CMV-PCR
  • Histopathology
  • Kidney
  • Transplant

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

CMV infection of the renal allograft is much more common than the pathology indicates : A retrospective analysis of qualitative and quantitative buffy coat CMV-PCR, renal biopsy pathology and tissue CMV-PCR. / Liapis, Helen; Storch, Gregory A.; Hill, D. Ashley; Rueda, Jose; Brennan, Daniel C.

In: Nephrology Dialysis Transplantation, Vol. 18, No. 2, 01.02.2003, p. 397-402.

Research output: Contribution to journalArticle

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abstract = "Background. Quantitative blood polymerase chain reaction (PCR) for cytomegalovirus (CMV) is used to direct therapy in kidney transplant patients, but cytomegalic inclusions are rarely found in allograft renal biopsies even with an elevated serum creatinine and apparent CMV disease. The relationship between quantitative blood CMV and renal allograft pathology is unknown. Methods. Thirteen biopsy samples were available for analysis from patients suspected of CMV disease, who had a buffy coat CMV-PCR drawn within 2-5 days of a renal allograft biopsy for an elevated creatinine. All were evaluated for CMV pathologically, by light microscopy, immunohistochemistry, in situ hybridization and tissue PCR. Results. Qualitative and quantitative buffy coat CMV-PCR were positive in 10/13 (77{\%}) patients. Tissue CMV-PCR was positive in five (50{\%}) biopsies, including two with CMV inclusions and three with no inclusions. Quantitative buffy coat CMV-PCR levels did not correlate with detection of CMV inclusions in renal tissue. Paradoxically, quantitative buffy coat CMV-PCR was low (239 and 538 copies/μg of DNA) when CMV inclusions were detected. All five biopsies with acute rejection were associated with CMV viraemia and two of the five with allograft CMV inclusions. A quantitative buffy coat CMV-PCR of",
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