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Prevention of CMV infection in transplant patients
1Transplantation Infectious Disease Program, Infectious Disease Division, Massachusetts General Hospital, Boston 02114, USA. jfishman@partners.org
Abstract:
Cytomegalovirus (CMV) is among the most important pathogens affecting the transplant recipient, with the spectrum of manifestations of CMV infection being quite broad. In the development of optimal strategies for the prevention and treatment of CMV infections, some of the most important information can be gained from patients who have failed either prophylaxis or therapy for CMV disease. Analysis of a cohort of these patients illustrates the role of primary infection in the immunologically naive patient for CMV, incompatibility of major histocompatibility complex (MHC) loci, and resistance to antimicrobial (antiviral) agents. Significant gaps in information include differentiating between viral strains, establishing the nature of viral latency, determination of host immunity to CMV, and optimal therapies for CMV infection. Elucidation of the factors that predispose to CMV infection will help to tailor and implement appropriate prophylactic strategies. New vaccines and orally bioavailable antiviral agents will play a significant role in the future care of transplant patients.
Insights
Understanding Cytomegalovirus (CMV) in transplant recipients is crucial. Analyzing patients with CMV treatment failure reveals insights into primary infection, MHC incompatibility, and antiviral resistance, guiding future prevention and therapy.
Area of Science:
- Infectious Diseases
- Transplantation Immunology
Background:
- Cytomegalovirus (CMV) is a significant pathogen in transplant recipients.
- CMV infection presents with a wide spectrum of clinical manifestations.
Purpose of the Study:
- To identify key factors contributing to Cytomegalovirus (CMV) infection and disease in transplant recipients.
- To inform the development of optimal strategies for CMV prevention and treatment.
Main Methods:
- Analysis of a patient cohort experiencing failure of CMV prophylaxis or therapy.
- Examination of factors including primary infection, MHC incompatibility, and antiviral resistance.
Main Results:
- Primary CMV infection in immunologically naive patients is a critical factor.
- Major histocompatibility complex (MHC) locus incompatibility contributes to CMV disease.
- Resistance to antiviral agents is observed in some patient cases.
Conclusions:
- Understanding factors predisposing to CMV infection is essential for tailoring prophylactic strategies.
- Future advancements in vaccines and oral antiviral agents are vital for managing CMV in transplant patients.