Cytomegalovirus Infection After Solid Organ Transplantation

Abstract

Cytomegalovirus (CMV) is the single most important pathogen affecting solid organ transplant (SOT) recipients. CMV may occur as a primary infection in CMV-naive patients after SOT, or it can be reactivation of latent donor or recipient infection in CMV-seropositive SOT recipients. CMV may present as a subclinical infection among SOT recipients with sufficient pathogen-specific immunity, or clinically apparent CMV-induced tissue damage, termed CMV disease, among SOT recipients without sufficient CMV specific immunity (such as CMV D+/R− SOT patients). CMV disease is manifested by fever, malaise, myelosuppression, and/or signs of end-organ involvement. CMV is also associated with numerous indirect effects, such as an increased risk of acute rejection, chronic allograft failure, and other opportunistic infections. Because of its negative impact, CMV prevention is a major focus of posttransplant management, accomplished either by preemptive therapy or antiviral prophylaxis. Treatment of CMV disease is accomplished by the use of intravenous ganciclovir or oral valganciclovir. Reduction in immunosuppression is recommended when dealing with severe cases of CMV disease. Resistance to ganciclovir is emerging, and may be treated with alternative drugs such as foscarnet and cidofovir. Several novel antiviral drugs are currently undergoing clinical trials for prevention and treatment of CMV disease.