Prophylaxis and treatment of cytomegalovirus disease in recipients of solid organ transplants

Current approach and future challenges

Yoram A. Puius, David R. Snydman

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

PURPOSE OF REVIEW: Cytomegalovirus infection is a major cause of morbidity and mortality in solid-organ transplant recipients, in terms of cytomegalovirus disease itself and the associated outcomes of organ rejection and death. This review focuses on recent literature concerning prevention and treatment of cytomegalovirus disease in this population. RECENT FINDINGS: Two major strategies for the prevention of cytomegalovirus infection in solid-organ transplant recipients - preemptive and prophylactic treatment - are reviewed. Both strategies result in a lower incidence of cytomegalovirus disease when compared to a 'wait and treat' approach, and are generally considered cost-effective. Neither prophylaxis nor preemption has yet been shown to be superior. Newer trials are also reviewed, which are beginning to evaluate protocols of preemption or prophylaxis representative of current practice, as well as to explore alternative dosing strategies, the benefits of cytomegalovirus immune globulin, and the potential benefit of a longer course of prophylaxis. Concerns for the selection of ganciclovir-resistant strains of cytomegalovirus are also addressed. SUMMARY: The consensus is that there is benefit for the treatment of solid-organ transplant patients with an antiviral agent before clinical evidence of cytomegalovirus disease. So far, there has been no demonstration of the superiority of prophylactic or preemptive regimens, nor has the exact nature and dosing of the oral antiviral agent of choice been established.

Original languageEnglish (US)
Pages (from-to)419-424
Number of pages6
JournalCurrent Opinion in Infectious Diseases
Volume20
Issue number4
DOIs
StatePublished - Aug 2007
Externally publishedYes

Fingerprint

Cytomegalovirus
Transplants
Cytomegalovirus Infections
Antiviral Agents
Therapeutics
Ganciclovir
Immunoglobulins
Morbidity
Costs and Cost Analysis
Mortality
Incidence
Population

Keywords

  • Antiviral therapy
  • Cytomegalovirus
  • Ganciclovir
  • Transplant
  • Valganciclovir

ASJC Scopus subject areas

  • Microbiology (medical)
  • Immunology

Cite this

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abstract = "PURPOSE OF REVIEW: Cytomegalovirus infection is a major cause of morbidity and mortality in solid-organ transplant recipients, in terms of cytomegalovirus disease itself and the associated outcomes of organ rejection and death. This review focuses on recent literature concerning prevention and treatment of cytomegalovirus disease in this population. RECENT FINDINGS: Two major strategies for the prevention of cytomegalovirus infection in solid-organ transplant recipients - preemptive and prophylactic treatment - are reviewed. Both strategies result in a lower incidence of cytomegalovirus disease when compared to a 'wait and treat' approach, and are generally considered cost-effective. Neither prophylaxis nor preemption has yet been shown to be superior. Newer trials are also reviewed, which are beginning to evaluate protocols of preemption or prophylaxis representative of current practice, as well as to explore alternative dosing strategies, the benefits of cytomegalovirus immune globulin, and the potential benefit of a longer course of prophylaxis. Concerns for the selection of ganciclovir-resistant strains of cytomegalovirus are also addressed. SUMMARY: The consensus is that there is benefit for the treatment of solid-organ transplant patients with an antiviral agent before clinical evidence of cytomegalovirus disease. So far, there has been no demonstration of the superiority of prophylactic or preemptive regimens, nor has the exact nature and dosing of the oral antiviral agent of choice been established.",
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