Cytomegalovirus Infections in Solid Organ Transplantation: A Review

Abstract

Cytomegalovirus (CMV) continues to have a tremendous impact in solid organ transplantation despite remarkable advances in its diagnosis, prevention and treatment. It can affect allograft function and increase patient morbidity and mortality through a number of direct and indirect effects. Patients may develop asymptomatic viremia, CMV syndrome or tissue-invasive disease. Late-onset CMV disease continues to be a major problem in high-risk patients after completion of antiviral prophylaxis. Emerging data suggests that immunologic monitoring may be useful in predicting the risk of late onset CMV disease. There is now increasing interest in the development of an effective vaccine for prevention. Novel antiviral drugs with unique mechanisms of action and lesser toxicity are being developed. Viral load quantification is now undergoing standardization, and this will permit the generation of clinically relevant viral thresholds for the management of patients. This article provides a brief overview of the contemporary epidemiology, clinical presentation, diagnosis, prevention and treatment of CMV infection in solid organ transplant recipients.

The pentameric complex of human Cytomegalovirus: cell tropism, virus dissemination, immune response and vaccine development

“…However, when primary (and sometimes non-primary) HCMV infections affect pregnant women, the virus can cause congenital infection, as well as a wide range of neurodevelopmental abnormalities [1]. In addition, in immunocompromised patients, HCMV infection may lead to life-threatening diseases [2,3]. Thus, an HCMV vaccine is considered to be a public health priority [4].…”

Intravenous immunoglobulins in liver transplant patients: Perspectives of clinical immune modulation

“…Important developments have since changed the perspectives of CMV infection, like assessment of specific donor (D)/recipient (R) risk constellations and the introduction of potent antiviral drugs (ganciclovir; valganciclovir). Between 1% and 30% of liver transplant patients are supposed to develop CMV disease in the absence of preventive strategies [115,116] . Indirect virus efficacies were demonstrated to account essentially for CMV-related morbidity and mortality [115,116] .…”

“…Between 1% and 30% of liver transplant patients are supposed to develop CMV disease in the absence of preventive strategies [115,116] . Indirect virus efficacies were demonstrated to account essentially for CMV-related morbidity and mortality [115,116] . These are mainly triggered by the capability of CMV to adversely modulate the recipients' immune system.…”

“…These are mainly triggered by the capability of CMV to adversely modulate the recipients' immune system. The virus was demonstrated to up-regulate alloantigens and to increase the risk of acute and chronic allograft rejection [115,116] . It may be associated with vanishing bile duct syndrome and ductopenic chronic rejection and, thus, with risk of cholestatic allograft dysfunction [117,118] .…”

“…In addition, CMV-induced immunologic imbalance increases the susceptibility for other opportunistic fungal and bacterial infections. Apart from that, risk of allograft fibrosis and inflammation may be enhanced and incidence of metabolic disorders was shown to be increased by CMV infection [115,116,120] . Looking at this harmful impact of CMV on the immune system, immuno-modulatory properties by CMVIg could be particularly useful for patients with an increased immunologic and infectious risk profile [21,22] .…”