Antiviral medications to prevent cytomegalovirus disease and early death in recipients of solid-organ transplants: a systematic review of randomised controlled trials

Impact of Antiviral Preventive Strategies on the Incidence and Outcomes of Cytomegalovirus Disease in Solid Organ Transplant Recipients

“…The preemptive approach consists in monitoring the CMV viral load and administering an antiviral drug in case of CMV detection in the blood, before the development of symptoms. Both strategies have greatly reduced CMV-associated morbidity and mortality (7,8), although the efficacy of the preemptive approach has been less well-established (9). Current guidelines recommend both approaches, although antiviral prophylaxis is generally preferred for high-risk patients (1,2).…”

A Case of Cytomegalovirus-Induced Arthritis after Lymphocyte-Depleting Therapy for Kidney Allograft Rejection

“…USRDS data have shown that recipients of CMV seropositive kidneys who do not receive prophylaxis have increased rates of CMV disease, allograft loss, and healthcare costs [12]. A recent Cochrane review found that prophylaxis for high risk patients reduces CMV infection, disease, and mortality in solidorgan transplant recipients by 39%, 58% and 37%, respectively [13].…”

Acceleration of allograft failure by cytomegalovirus

“…There is significant controversy in the transplant literature regarding the appropriate timing of therapy, as well as the indication for therapy, i.e. preemptive vs. prophylaxis [1,[16][17][18][19][20][21]. The notion of treating subclinical infection has been studied and it was determined that aggressive prophylaxis post heart transplantation with ganciclovir, valciclovir and CMVIG in D+/R− patients resulted in a reduction in viral levels, acute rejection, and cardiac allograft vascular disease, compared to standard prophylaxis that was used in R+ patients [22].…”

“…The notion of treating subclinical infection has been studied and it was determined that aggressive prophylaxis post heart transplantation with ganciclovir, valciclovir and CMVIG in D+/R− patients resulted in a reduction in viral levels, acute rejection, and cardiac allograft vascular disease, compared to standard prophylaxis that was used in R+ patients [22]. Furthermore, Sagedal et al demonstrated that kidney transplant allograft survival was decreased in asymptomatic HCMV infected recipients during the first 100 days post transplantation compared to patients with no HCMV infection suggesting that the presence of HCMV alone, whether asymptomatic or with overt infection, has a negative impact on graft survival [1]. There is a clear advantage to long-term CMV-specific T-cell responses in lung transplant recipients demonstrating that control of CMV infection during transplantation is beneficial [23,24].…”

“…In addition to direct disease, many groups over the past three decades have implicated HCMV in the acceleration of long term disease processes such as increased graft loss due to acute and chronic rejection (CR) in bone marrow and solid organ transplant (SOT) patients. The best evidence that CMV is involved in acute and CR is based on studies with the anti-HCMV drug ganciclovir in humans and animal models that demonstrate a reduction in allograft failure in a wide range of SOT recipients and in bone marrow transplants [1]. Understanding the mechanisms involved in HCMV acceleration of chronic allograft rejection may provide potential targets for therapeutic intervention.…”