628. Cytomegalovirus (CMV) Viral Load in Bronchoalveolar Lavage Fluid (BALF) and Plasma to Diagnose Lung-Transplant Associated CMV Pneumonia
Session: Oral Abstract Session: Epidemiology of Transplant Infections
Thursday, October 8, 2015: 2:30 PM
Room: 25--ABC

Background: Both the correlation between CMV PCR viral load in BALF and in plasma, as well as the ability of the CMV PCR on BALF to diagnose CMV pneumonia in lung transplant recipients, remain uncertain and were evaluated in a cohort of lung transplant recipients. 


Methods: Positive CMV PCR measurements in BALF taken within the first year of transplantation in consecutive lung transplant recipients, who had a pre-transplant CMV IgG serostatus of either D+/R+, D+/R- or D-/R+ (n=67), were included (n=148). At each bronchoscopy episode, case notes were reviewed to classify whether CMV pneumonia was present or not. CMV pneumonia was defined as relevant symptoms, infiltrative changes on chest X-ray or CT, and further supported by a CMV positive biopsy with immunohistochemistry. The viral load of plasma CMV PCR samples taken within +/- 7 days of each bronchoscopy (n=130) was correlated with viral load in BALF. Optimal cut off for diagnosis of CMV pneumonia for CMV PCR on BALF was determined using receiver operating characteristics (ROC).


Results: Of the 148 episodes, 32 (22%) represented cases with CMV pneumonia. Both the median (IQR) viral load in BALF and in plasma was significantly higher amongst recipients with CMV pneumonia (see table). The correlation between CMV viral load in BALF and plasma was 55% (p<0.0001) (figure 1). Area under the curve for the ROC of the sensitivity and specificity of CMV PCR in BALF was 90.4%; at a cut off of 5,050 copies/ml in BALF, CMV pneumonia can be diagnosed with a sensitivity of 91% and a specificity at 75% (figure 2).


Conclusion: CMV viral load in BALF was substantially higher for CMV pneumonia episodes than for episodes with detectable CMV in BALF but without evidence of pneumonia; optimal diagnostic cuff-off was 5,050 copies/mL. BALF CMV viral load was positively correlated with viral load in plasma for cases with positive CMV PCR in plasma. CMV PCR in plasma was more likely to be positive if CMV pneumonia was present, but 37% of CMV pneumonia cases had negative plasma CMV PCR. Hence, CMV PCR in BALF showed a high diagnostic accuracy for CMV pneumonia, and is suggested to be used to detect this high-risk condition in lung transplant patients allowing timely initiation of antiviral therapy.


Isabelle Paula Lodding, Medical Student1, Hans Henrik Schultz, MD2, Jens Ulrik Jensen, MD, PhD1, Claus Andersen, MD, DMSc3, Michael Perch, MD, PhD2, Jens Lundgren, MD, D.M.Sc, Professor1 and Martin Iversen, MD, D.M.Sc.2, (1)Chip, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark, (2)Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark, (3)Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark


I. P. Lodding, None

H. H. Schultz, None

J. U. Jensen, None

C. Andersen, None

M. Perch, None

J. Lundgren, None

M. Iversen, None

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