pISSN 2671-8790 eISSN 2671-8804

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Korean J Transplant 2022; 36(1): 15-28

Published online March 31, 2022

https://doi.org/10.4285/kjt.22.0001

© The Korean Society for Transplantation

Laboratory diagnostic testing for cytomegalovirus infection in solid organ transplant patients

Hyeyoung Lee1 , Eun-Jee Oh2,3

1 Department of Laboratory Medicine, International St. Mary’s Hospital, College of Medicine, Catholic Kwandong University, Incheon, Korea
2 Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
3 Research and Development Institute for In Vitro Diagnostic Medical Devices of Catholic University of Korea, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to: Eun-Jee Oh
Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
Tel: +82-2-2258-1641
Fax: +82-2-2258-1719
E-mail: ejoh@catholic.ac.kr

Received: January 19, 2022; Revised: February 12, 2022; Accepted: February 15, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Human cytomegalovirus (CMV) infection, which is one of the most common complications in transplant recipients, increases the risk of graft loss and rejection. Laboratory strategies for diagnosing CMV infection rely on the measurement of viral DNAemia and CMV-specific cell-mediated immunity (CMV-CMI). The CMV quantitative nucleic acid amplification test (QNAT) enabled the spread of preemptive therapy and prompted recommendations for surveillance, diagnosis, and monitoring. Despite the implementation of the World Health Organization international standard for calibration, variability of QNAT persists due to technical issues. CMV immunoglobulin G serology is the standard method for CMV immune screening of transplant candidates and donors. Assays for CMV-CMI play an important role in helping to predict the risk and to develop an individualized CMV management plan. Genotypic testing for resistance is needed when drug-resistant CMV infection is suspected. Here, we review the state of the art of laboratory tests for CMV infection in solid organ transplantation.

Keywords: Transplantation, Cytomegalovirus, Cell-mediated immunity, Serology, Viral load

HIGHLIGHTS
  • Cytomegalovirus (CMV) quantitative nucleic acid amplification test is a rapid and sensitive method of diagnosing CMV infection and is preferred for CMV surveillance to guide preemptive treatment.

  • CMV-specific cell-mediated immunity (CMV-CMI) in transplant recipients can be assessed before transplantation to determine their baseline immunity.

  • Immune monitoring by measuring CMV‐CMI might be useful for stratifying the risk of CMV infection and managing the posttransplant strategy.

  • Genotype resistance testing should be performed when drug-resistant CMV infection is suspected.