Cytomegalovirus infection and disease after liver transplantation

Abstract

Cytomegalovirus is the single most important pathogen in clinical transplantation. Although much progress has been made in our understanding of the molecular biology and epidemiology of CMV infection and in our ability to diagnosis and treat CMV disease, it remains a major cause of morbidity but is no longer a major cause of mortality after liver transplantation. Risk factors for CMV disease after liver transplantation include donor and recipient serologic status, the use of antilymphocyte therapy, and retransplantation. CMV disease occurs early after transplantation, and the most frequent site of disease is the hepatic allograft. We have treated 79 patients with intravenous ganciclovir, with ultimate control of disease achieved in 69 patients (87.3%). Preliminary results using intravenous immunoglobulin and oral acyclovir for CMV prophylaxis in high-risk patients have been encouraging. In addition to producing clinical syndromes. CMV may have direct immunologic effects and is a marker of the net state of immunosuppression.

New Strategies for Prevention and Therapy of Cytomegalovirus Infection and Disease in Solid-Organ Transplant Recipients

“…Less common presentations of CMV disease in organ transplant recipients include CMV involvement of the ureter, epididymis, skin, endometrium, and central nervous system (encephalitis, transverse myelitis) (233,258,291,307,330,337,346,362,403,444,452). There are anecdotal reports of CMV causing laryngitis (269), glomerulonephritis (167), and cutaneous infection (337) in solid-organ transplant recipients.…”

Management of cytomegalovirus infection after liver transplantation

“…8,9 An increased incidence of fungal, bacterial, and Pneumocystis carinii infections has been reported in patients with CMV disease. 8,[10][11][12] The exact mechanisms by which CMV alters the host immune system in a global manner remains unknown, although multiple mechanisms have been postulated. In addition, CMV infection has been hypothesized to enhance allograft rejection, although this is controversial.…”

Comparison of LightCycler-Based PCR, COBAS Amplicor CMV Monitor, and pp65 Antigenemia Assays for Quantitative Measurement of Cytomegalovirus Viral Load in Peripheral Blood Specimens from Patients after Solid Organ Transplantation

“…Despite significant advances resulting from the use of preemptive and prophylactic antiviral therapy for the prevention of cytomegalovirus (CMV) disease after solid organ transplantation, CMV continues to cause morbidity and mortality in this setting (15,29,30,31). Appropriate management of these patients is dependent on the early detection and quantitation of CMV viremia and/or CMV DNAemia to identify patients at greatest risk for CMV disease, diagnose infection, and determine response and duration of antiviral therapy (1,8,13,23,24,25).…”