Cytomegalovirus detection in lung transplant biopsy samples by polymerase chain reaction

Cytomegalovirus lung infection may produce perivascular lymphocytic infiltrates indistinguishable from those found in lung biopsy samples obtained from lung transplant recipients with acute rejection. With the polymerase chain reaction used to detect cytomegalovirus DNA, 43 transbronchial samples from 26 lung or combined heart-lung transplant recipients were analyzed, as were lung biopsy samples (devoid of characteristic cytomegalic cells) obtained from 18 non-lung transplant recipients who were not immunosuppressed. Of 25 samples manifesting acute rejection, nine contained cytomegalovirus DNA. Eight samples negative for rejection also contained cytomegalovirus DNA. Cytomegalovirus DNA was detected in 2 of 18 samples from the patients not undergoing transplantation. A significant correlation was noted between cytomegalovirus culture and polymerase chain reaction results (p = 0.01). There was no association between the presence of cytomegalovirus DNA sequences and patient antibody titer status or histologic evidence of rejection (p > 0.5). Cytomegalovirus sequences were found in 44% of transplant lung samples that did not manifest perivascular infiltrates or other evidence of rejection and 36% of transplant samples manifesting perivascular infiltrates. From these results it would seem that cytomegalovirus infection is just as likely not to be accompanied by perivascular infiltrates as to be associated with them. It may be appropriate to regard perivascular lymphoid infiltrates as more likely a sign of acute rejection.