Logo Annals of Transplantation Logo Annals of Transplantation Logo Annals of Transplantation

21 May 2009

CMV infections

K Ciechanowski

Ann Transplant 2009; 14(1): 17-17 :: ID: 880255

Abstract

It is estimated that three-quarters of all patients undergoing solid organ transplantation experience new infection or reactivation of latent cytomegalovirus (CMV). In all transplant types, seronegative recipients of organs from seropositive donors (D+/R-) are at the highest risk to develop CMV infection and more serious disease. The American Society of Transplantation standardized diagnostic criteria for CMV infection and disease are presented below: 1. CMV infection: isolation of virus, viral protein or nucleic acid from any tissue or body fluid; primary infection - emergence of CMV or CMV specific antibodies in untreated patients previously CMV seronegative, recurrent infection - new infection in patients with previous history, but without evidence of infection over >1 month of active surveillance. 2. CMV syndrome: CMV in the blood, plus >1 of the following: 1) fever >38°C (>2 days), 2) thrombocytopenia, leucopenia, or anemia, 3) worsening/ new malaise, 4) transaminase increases in non liver transplant recipients. 3. CMV disease: isolation of virus, or evidence of viral replication in the presence of clinical symptoms of organ specific disease (end- organ disease) such as pneumonia, gastrointestinal disease, hepatitis, central nervous system disease, nephritis, cystitis, myocarditis and retinitis. Current antiviral agents and preventive strategies have led to a decrease in incidence of CMV disease. Compared to patients treated with no viral therapy, those receiving preemptive therapy and prophylaxis have a 72-80% lower likelihood for the development of CMV disease. Futhermore, reduced allograft rejection, opportunistic infections and mortality has been documented with the receipt of prophylaxis. Although prophylaxis has effectively prevented early CMV disease, the incidence of late-onset CMV disease occurring after discontinuation of prophylaxis has increased from 0-5% in the era of long-term use of acyclovir to 2.6-7% in patients receiving prophylaxis with oral ganciclovir. Valganciclovir has emerged as the preffered antiviral agent for prevention of CMV in solid-organ recipients because of its oral availability, convenient dosing schedule, and 10-fold oral bioavailability then oral ganciclovir. Evidence-based systematic synthesis data show that overall incidence of CMV disease in patients receiving valganciclovir prophylaxis was 9.9% and 2.6% in preemptive therapy group. The overall rejection rate of 10.8% was in patients receiving preemptive therapy and 17.6% in prophylactic studies. In preemptive therapy group 3.9% patients had graft loss. Prophylactic studies described the number of patients with graft loss, and the overall rate was 2.5%. Opportunistic infections developed 28.5% in preemptive therapy groups and 7.8% in prophylactic studies. The overall mortality rate was 8.2% from preemptive studies and 4.4% from prophylactic groups. Both prophylaxis and preemptive strategies are effective for CMV disease prevention. The peak incidence of CMV disease has shifted from

Keywords: CMV infections, Organ Transplantation, Cytomegalovirus

Add Comment 0 Comments

In Press

Original article  

Retrospective Study to Compare Outcomes in 159 Patients Undergoing First Autologous Stem Cell Transplantati...

Ann Transplant In Press; DOI: 10.12659/AOT.947186  

Case report  

Pulmonary Embolism Following Living Donor Hepatectomy: A Report of 4 Cases and Literature Review

Ann Transplant In Press; DOI: 10.12659/AOT.946752  

Most Viewed Current Articles

03 Jan 2023 : Original article   6,513

Impact of Autologous Stem Cell Transplantation on Primary Central Nervous System Lymphoma in First-Line and...

DOI :10.12659/AOT.938467

Ann Transplant 2023; 28:e938467

15 Aug 2023 : Review article   6,136

Free-Circulating Nucleic Acids as Biomarkers in Patients After Solid Organ Transplantation

DOI :10.12659/AOT.939750

Ann Transplant 2023; 28:e939750

16 May 2023 : Original article   6,130

Breaking Antimicrobial Resistance: High-Dose Amoxicillin with Clavulanic Acid for Urinary Tract Infections ...

DOI :10.12659/AOT.939258

Ann Transplant 2023; 28:e939258

17 Jan 2023 : Original article   5,257

Non-Cryopreserved Peripheral Blood Stem Cell Graft for Autologous Hematopoietic Stem Cell Transplantation i...

DOI :10.12659/AOT.938595

Ann Transplant 2023; 28:e938595

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358