Abstract
Cytomegalovirus is the classic opportunistic infection after solid organ transplantation. This review
will discuss updates and future directions in the diagnosis, prevention and treatment of CMV infection in solid
organ transplant recipients. Antiviral prophylaxis and pre-emptive therapy are the mainstays of CMV prevention,
but they should not be mutually exclusive and each strategy should be considered depending on a specific situation.
The lack of a widely applicable viral load threshold for diagnosis and preemptive therapy is emphasized as a
major factor that should pave the way for an individualized approach to prevention. Valganciclovir and intravenous
ganciclovir remain as drugs of choice for CMV management, and strategies for managing drug-resistant
CMV infection are enumerated. There is increasing use of CMV-specific cell-mediated immune assays to stratify
the risk of CMV infection after solid organ transplantation, and their potential role in optimizing CMV prevention
and treatment efforts is discussed.
Keywords:
Cytomegalovirus, valganciclovir, foscarnet, cidofovir, transplantation, ganciclovir.
[30]
Meesing A, Abraham R, Razonable RR. Clinical correlation of cytomegalovirus infection with CMV-specific CD8+ T-Cell immune competence score and lymphocyte subsets in solid organ transplant recipients. Transplantation 2018; 103(4): 32-838.
[32]
Eid AJ, Brown RA, Hogan WJ, et al. Kinetics of interferon-gamma
producing cytomegalovirus (CMV)-specific CD4+ and CD8+ T
lymphocytes and the risk of subsequent CMV viremia after allogeneic
hematopoietic stem cell transplantation. Transplant Infect Dis:
an official journal of the Transplantation Society 2009; 11: 519-28.
[73]
Singh N, Winston DJ, Razonable RR, et al. Preemptive therapy versus prophylaxis for prevention of cytomegalovirus disease in high-risk donor seropositive/recipient-seronegative liver transplant recipients: a NIH-sponsored, randomized, controlled, multicenter trial. In: IDWeek. San Francisco, CA: IDSA 2018.
[131]
Smith C, Beagley L, Rehan S, et al. Autologous adoptive T-cell therapy for recurrent or drug-resistant cytomegalovirus complications in solid organ transplant patients: A single-arm open-label phase I clinical trial. Clin Infect Dis 2018; 68(4): 632-40.