FIG. 5.

Illustration of possible guidelines for the interpretation of plasma CMV DNA values after transplantation, based on the observations described in this study. To formulate these guidelines, the threshold values as derived from the ROC analysis were rounded off to the nearest decimal. In these guidelines, some practical approaches are different for SOT and SCT recipients. In the case of SOT recipients, thresholds are defined only for recipients at risk for CMV reactivation. SOT recipients at risk for primary CMV infection (D+/R−) have never encountered CMV, and therefore any level of CMV DNA is considered to be evidence of imminent clinically relevant infection. Primary infections are more difficult to define in the case of SCT recipients, as the level of grafted donor immunity is highly variable with regard to CMV. Therefore, a distinction is made between the first CMV episode and any subsequent episodes after transplantation. During the first episode, the threshold is set more stringently than for the subsequent episodes.