Quantitative analysis of CMV DNA in children the first year after liver transplantation CMV infection is an important cause of compli- cations in adults and children receiving solid organ transplants (1, 2). CMV disease typically presents with fever, neutropenia, malaise, hepa- titis or other gastrointestinal symptoms within 3 months of transplantation. In addition CMV infection increases the risk for acute and chronic rejection (3, 4), Epstein-Barr virus related lymphoproliferative disease (5), bacteraemia (6) and invasive fungal infection (7). In the absence of prophylactic measures, some form of CMV infection is seen in 30–60% of liver transplant recipients (8, 9). CMV disease evolves in about one third of these and is mainly observed if a CMV seronegative patient receives an organ from a seropositive donor (10). Complications of CMV infection can be reduced by antiviral treatment with ganciclovir. Such treatment may be given as prophylaxis, on a preemptive basis (i.e. treatment administered when laboratory tests indicate CMV activation), or on clinical indication of CMV disease. Detec- tion by PCR has proven valuable for an early and correct diagnosis (11), which is important for avoiding delay in treatment when indicated, or unnecessary ganciclovir therapy. Recently quan- titative analysis of CMV DNA has been pro- posed to improve the identification of significant symptomatic CMV infection (12, 13). As yet, data on liver-transplanted children are scarce (14, 15), and the value of highly sensitive quantitation of CMV DNA in this group of patients is not yet established. Kullberg-Lindh C, Ascher H, Krantz M, Lindh M. Quantitative analysis of CMV DNA in children the first year after liver transplantation. PediatrTransplantation2003:7:296–301. Ó 2003BlackwellMunksgaard Abstract: CMV infection is a major problem after solid organ trans- plantation especially in children where primary infection is more com- mon than in adults. Early diagnosis is critical and might be facilitated by quantitative analysis of CMV DNA in blood. In this retrospective study of 18 children who had a liver transplantation 1995–2000, serum samples were analysed by Cobas Amplicor Monitor (Roche). Four patients developed symptomatic CMV infection at a mean time of 4 wk after transplantation. They showed maximum CMV DNA levels in serum of 26 400, 1900, 1300 and 970 copies/mL, respectively. In com- parison, CA Monitor was positive, at a low level (415 copies/mL), in one of 11 patients with asymptomatic (4) or latent (7) infection. CMV IgM was detected at significant levels (‡1/80) in all four patients with symptomatic, and in one with asymptomatic CMV infection. Eight patients were given one or several courses of ganciclovir. Five of these lacked symptoms of CMV disease, and had low (415 copies/mL) or undetectable CMV DNA in serum. The data suggest that quantitative analysis of CMV DNA may be of value in early identification of CMV disease and for avoiding unnecessary antiviral treatment. Carola Kullberg-Lindh, Henry Ascher, Marie Krantz and Magnus Lindh Departments of Pediatrics and Clinical Virology, Göteborg University, Göteborg, Sweden Key words: cytomegalovirus – immunosuppression – polymerase chain reaction Carola Kullberg-Lindh, Department of Pediatrics, Queen Silvia Children's Hospital, 416 85 Göteborg, Sweden E-mail: carola.kullberg-lindh@pediat.gu.se Accepted for publication 2 April 2003 Abbreviations: ALT, alanine aminotransferase; ATG, antithymocyte globulin; CA, Cobas Amplicor; CMV, cytomegalovirus; CsA, cyclosporine A; EHBA, extrahe- patic biliary atresia; ELISA, enzyme-linked immunosorb- ent assay; HCV, hepatitis C virus; OKT3, anti-CD3 lymphocyte monoclonal antibody; PCR, polymerase chain reaction; ULN, upper limit of normal. Pediatr Transplantation 2003: 7: 296–301 Printed in UK. All rights reserved Copyright Ó 2003 Blackwell Munksgaard Pediatric Transplantation ISSN 1397-3142 296