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Serologic screening for cytomegalovirus (CMV) has been done in both potential donors and recipients in renal transplantation. In my case, the living-related donor (sister) is CMV IgG positive and CMV IgM negative. The recipient, however, is CMV IgG positive and CMV IgM positive. Should we go ahead with renal transplantation?
Safdar Hassan Sial, MD
In general, elective transplantation should be postponed until after the potential recipient has cleared his or her active CMV disease. That's the stock answer...but, does your recipient actually have CMV disease? There is some important information missing from your question. If your patient has recently seroconverted, or is symptomatic (ie, fever, neutropenia, pneumonia, gastroenteritis, hepatitis, retinitis) I would consider treating him/her for some period of time (ie, 6-12 weeks) and then reconfirming by polymerase chain reaction (PCR) that the viral load has cleared prior to transplantation.
If your patient is asymptomatic, I would check a viral load (using PCR) or at least obtain an antigenemia (pp65) assay. If these tests are negative, it is likely that the IgM was a false positive; in that case I would go ahead with transplantation. In the best-case scenario, IgM assays have a positive predictive value of only 70% for active CMV disease. I would, in either instance, use postoperative prophylaxis for CMV disease. This patient has an approximately 5-7 times greater risk of developing CMV disease in the first year posttransplantation compared with CMV-seronegative recipients of organs from CMV-seronegative donors.
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