Clinical Usefulness of Human Cytomegalovirus Antigenemia Assay after Kidney Transplantation

Tark Kim; Heungsup Sung; Kwan Tae Park; Song Cheol Kim; Sung-Han Kim; Sang-Ho Choi; Yang Soo Kim; Jun Hee Woo; Su-Kil Park; Duck Jong Han; Sang-Oh Lee

doi:10.3947/ic.2009.41.2.72

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Kim, Sung, Park, Kim, Kim, Choi, Kim, Woo, Park, Han, and Lee: Clinical Usefulness of Human Cytomegalovirus Antigenemia Assay after Kidney Transplantation

Original Article

Infection and Chemotherapy

Infection and Chemotherapy 2009; 41(2): 72-77.

Published online: 30 April 2009

DOI: https://doi.org/10.3947/ic.2009.41.2.72

Clinical Usefulness of Human Cytomegalovirus Antigenemia Assay after Kidney Transplantation

Tark Kim, M.D.¹, Heungsup Sung, M.D.², Kwan Tae Park, M.D.³, Song Cheol Kim, M.D.³, Sung-Han Kim, M.D.¹, Sang-Ho Choi, M.D.¹, Yang Soo Kim, M.D.¹, Jun Hee Woo, M.D., Ph.D.¹, Su-Kil Park, M.D.¹, Duck Jong Han, M.D.³, Sang-Oh Lee, M.D.¹

¹Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

²Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

³Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence: Sang-Oh Lee, M.D. Department of Infectious Diseases, Asan Medical Center, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3301, Fax: +82-2-3010-6970, soleemd@amc.seoul.kr

Received 7 October 2008 Accepted 19 December 2008

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

This study was performed to determine the cut-off value and the predictability of symptomatic human cytomegalovirus (HCMV) infection according to the peak value of HCMV antigenemia assay in kidney transplant recipients.

Materials and Methods

We reviewed the results of HCMV antigenemia assay (Chemicon, CA, USA) in patients who received kidney transplantation at our institution from May 2003 through May 2008, and investigated the existence and the type of HCMV infection by the medical record review. Patients who underwent the test only once during the episode or those who received ganciclovir for more than 48hrs before the test were excluded. The receiver-operator characteristic curve was drawn and the point showing maximum likelihood ratio (LR) was chosen as the cut-off value of symptomatic HCMV infection.

Results

A total of 689 episodes were screened and 134 episodes were enrolled. Thirty-three (24.6%) episodes were symptomatic HCMV infection, 23 (17.2%) episodes were associated with HCMV syndrome, and 10 (7.5%) episodes were tissue-invasive diseases. The maximum LR was 7.5 (95% confidence interval, 4.014.2) and the cut-off value was 29.5 cells/200,000 WBC. The sensitivity, specificity, positive predictive value, and negative predictive value were 66.7%, 91.1%, 71.0%, and 89.3%, respectively.

Conclusions

The cut-off value of symptomatic HCMV infection by the peak value of HCMV antigenemia assay in our study was similar with previous results, although the sensitivity was relatively low.

Keywords: Human cytomegalovirus, Antigenemia, Kidney transplantation

Figures and Tables

Figure 1

Receiver operator characteristic curve of the peak value of human cytomegalovirus (HCMV) antigenemia assay. The likelihood ratio (LR) was highest at point A (LR, 7.5; 95% confidence interval, 4.0-14.2). The peak value of HCMV antigenemia assay in point A was 29.5 cells/200,000 WBC (sensitivity 66.7% and specificity 90.1%).

Figure 2

The peak value of human cytomegalovirus (HCMV) antigenemia assay by ganciclovir prophylaxis in patients with symptomatic HCMV infection within 6 months after kidney transplantation. A total of 28 events were enrolled within 6 months. Among them, 5 patients received ganciclovir iv 1.25-10 mg/kg/day for 2 weeks (closed circle) and only one patient received ganciclovir iv 0.625 mg/kg/day for 3 weeks (closed diamond) as primary prophylaxis.

Table 1

Percentile Peak Value of Human Cytomegalovirus (HCMV) Antigenemia Assay according to the Type of HCMV Infection

Table 2

The Predictability of Symptomatic Human Cytomegalovirus (HCMV) Infection according to the Peak Value of HCMV Antigenemia Assay

Abbreviations : PPV, positive predictive value; NPV, negative predictive value

Table 3

Clinical Characteristics of Patients with Symptomatic Human Cytomegalovirus (HCMV) Infection beyond 6 months after Kidney Transplantation

Abbreviations: KT, kidney transplantation; LU, living unrelated

^*Peak value of HCMV antigenemia assay (cells/200,000 WBC)

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