Transition from Cytomegalovirus Antigenemia Assay and Whole-Blood Quantitative PCR to Automated Plasma Quantitative PCR in Solid Organ Transplant Recipients: Correlation of Viral Loads and Impact on Treatment Eligibility Based on a Single-Center Retrospective Study

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Background: Cytomegalovirus (CMV) antigenemia assay (AG) and whole-blood (WB) quantitative (q)PCR have long been used for monitoring CMV reactivation in solid organ transplant (SOT) recipients. Automated plasma qPCR has enabled faster turnaround and timely intervention. We compared automated plasma qPCR with conventional methods to determine CMV pre-emptive therapy thresholds. Methods: In this single-center retrospective study, liver transplant (LT) and kidney transplant (KT) recipients underwent AG, WB qPCR, and plasma qPCR on the same day. Correlations between these assays were assessed using Spearman's rank correlation, linear, and Tobit regression. qPCR performance was evaluated using ROC analysis, with AG thresholds as the reference standard. Results: (AG cells/200,000 white blood cells)+2.81. Based on AG thresholds ( ≥ 5 for LT; ≥ 25 for KT), clinical feasibility, and treatment burden, institutional plasma qPCR thresholds of 2,000 IU/mL (LT) and 10,000 IU/mL (KT) were established. Conclusions: By establishing organ-specific plasma qPCR thresholds, this study provides a framework for transitioning from AG- or WB-based monitoring to automated plasma qPCR-guided CMV surveillance.

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