Cytomegalovirus infection in living related liver transplantation: rapid diagnosis by human monoclonal antibody staining of blood leucocytes.

Symptomatic cytomegalovirus (CMV) infection is a major cause of morbidity and mortality following orthotopic liver transplantation. Early detection and prompt treatment with appropriate medicine are crucial for successful outcome. As an early detection method, we used the CMV antigenemia test which is based on immunocytochemical detection of CMV immediate early antigens in blood leucocytes. CMV immediate early antigens were detected in blood leucocytes with direct immunoperoxidase technique using a horseradish peroxidase (HRP)-conjugated F(ab')2 fragment of human monoclonal antibody (humab C7), designated HRP-C7. Of the 37 living related liver transplantations we performed on pediatric patients between June 1990 and August 1992, we experienced four cases (10.8%) of symptomatic CMV infection: three CMV hepatitis and one CMV peritonitis. They were all treated successfully with a combination of ganciclovir and immunoglobulins. In ABO-incompatible cases ganciclovir was administered prophylactically. Early detection using this method is though to have led to these successful outcomes. It is concluded that HRP-C7 staining of blood leucocytes is useful for the rapid diagnosis of CMV infection.