Emerging Perspectives in TransplantationRenal transplantationClinical Utility of Viral Load in the Management of Cytomegalovirus Infection in Solid Organ Transplant Patients in Kuwait

- Quantitative real-time PCR assays of CMV were conducted on plasma samples to detect and monitor CMV DNA viral load in 1,168 patients in Kuwait who had had received solid organ transplants.
- Peak CMV DNA loads were significantly higher in symptomatic patients than in asymptomatic patients.
- Many symptomatic patients were successfully treated, and their viral loads declined.
- Some symptomatic patients had irregular viral load kinetics, with prolonged periods of symptoms despite CMV treatment.

BackgroundInfection with human cytomegalovirus (CMV) in solid organ transplant patients remains an unresolved challenge, despite improvements in immunosuppressive therapy, post-transplantation care, viral prevention, and therapy.MethodsWe conducted quantitative real-time polymerase chain reaction (PCR) assays of CMV on plasma samples of 1,168 patients in Kuwait who received solid organ transplants from 2012 to 2014 to detect and monitor CMV DNA viral load.ResultsOf the 1,168 patients, 180 (15.4%) were positive for CMV DNA. Among the CMV DNA-positive patients, 119 (66.1%) remained without symptoms and 61 (33.9%) developed CMV-related symptoms. During the follow-up period, peak viral loads were significantly (P < .05) higher in symptomatic patients (mean 970 copies/mL; range, 15-625,000 copies/mL) than in asymptomatic patients (<150 copies/mL; range, 67-2,650 copies/mL). Many symptomatic patients (n = 57) were successfully treated, and their viral loads declined. However, some symptomatic patients had irregular viral-load kinetics, with prolonged periods of symptoms despite CMV treatment; we excluded the possibility of drug resistance in these patients, because there was no evidence of clinical resistance to treatment.ConclusionsQuantitative real-time PCR of CMV DNA is useful in monitoring CMV infection and the effectiveness of CMV treatment in renal transplant recipients in Kuwait.