TABLE 4.

Utility of BAL fluid viral load determination for diagnosis of CMV pneumonia in SOT recipients^f

Authors (reference)	Yr	Transplant type(s)	Study design and population	Total no. of patients	No. of CMV pneumonia cases	Median VL			% of CMV pneumonia cases with positive blood PCR (no. of positive cases/total no. of cases)	Findings	Conclusion(s)
						BAL fluid, in CMV pneumonia cases	TBB samples, in CMV pneumonia cases	BAL fluid, in non-CMV pneumonia cases
Lodding et al. (62)	2018	Lung	Retrospective cohort study; lung transplant patients with positive CMV PCR of BAL fluid	141; 66 CMV PCR+	34a	32,940 IU/ml	NR	1,260 IU/ml	88 (30/34), plasma	For BAL CMV PCR, 91% sensitivity and 77% specificity at VL cutoff of 4,545 IU/ml	CMV BAL fluid PCR was a useful tool for diagnosing CMV pneumonia in lung transplant recipients
Costa et al. (63)	2013	Lung	Prospective cohort study; positive CMV PCR on matched TBB, BAL, and whole-blood specimens	33	7b	5.9 × 104 copies/mlc (4 cases)	4.4 × 104 copies/mlc	5.6 × 104 copies/mlc	43 (3/7), whole blood	CMV pneumonia was associated with CMV PCR+ result for TBB samples and whole blood but not BAL fluid	CMV evaluation of TBB samples could represent a useful tool to discriminate between asymptomatic and clinical infection with consequent organ disease
Beam et al. (64)	2018	Lung, OLT, KT, HCT, nontransplant	Retrospective case-control study; comparison of CMV pneumonia vs non-CMV pneumonia cases	38, 22d	17, 5d	>1.82 × 107 IU/mld	NR	7,500 IU/ml	100 (5/5),d plasma	For all transplant patients, CMV BAL fluid PCR for pneumoniae had a 91.7% sensitivity and a 100% specificity at a VL cutoff of 34,800 IU/ml	CMV BAL fluid PCR may improve the clinician’s ability to diagnose CMV pneumonia without the need for and associated risks of lung biopsy
Wiita et al. (65)	2012	Lung	Retrospective and prospective cohort study; evaluation of CMV detection in the setting of indefinite valganciclovir prophylaxis	128	2	650,000 copies/ml	NR	<20,000 copies/ml	NR	Compared with shell vial culture, BAL fluid PCR showed a sensitivity of only 36% and a specificity of 99%; however, results were not compared to IHC results	BAL fluid PCR was significantly more sensitive than shell vial culture; however, BAL fluid CMV VL was not predictive of subsequent disease development

^aProbable and proven cases.

^bDocumented by histopathology and immunohistochemistry.

^cMean.

^dLung transplant recipients, all with proven pneumonia.

^ePossible, probable, and proven pneumonia (n = 12).

^fNR, not reported; TBB, transbronchial biopsy; VL, viral load; OLT, orthotopic liver transplant; BAL, bronchoalveolar lavage.