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Indirect effects of CMV in the solid organ transplant patient
1Division of Infectious Diseases and Transplant Center, Mayo Clinic, Rochester, Minnesota 55905, USA. paya@mayo.edu
Abstract:
Recent research has led to the identification of risk factors for cytomegalovirus (CMV) infection and disease in the solid organ transplant patient, leading to increasingly effective prophylactic regimens. These strategies have led to a decreased incidence of CMV infection and disease and a decrease in what has become known as the "direct" effects of CMV. Accumulating evidence, however, suggests that there are several "indirect" effects of CMV infection, which significantly impact management and outcome of transplant recipients. Some of the postulated indirect effects of CMV infection in this population include various opportunistic infections and graft rejection, as well as the attendant increased cost and resource utilization by transplant programs. An evaluation of such indirect effects may allow us to improve our care of the transplant population while reducing cost and resource use.
Insights
Cytomegalovirus (CMV) infection in transplant patients has direct effects that are now well-managed. However, indirect CMV effects like graft rejection and increased costs require further evaluation for improved patient care.
Area of Science:
- Transplant medicine
- Infectious diseases
- Immunology
Background:
- Solid organ transplant recipients are at risk for cytomegalovirus (CMV) infection.
- Effective prophylactic regimens have reduced the incidence of direct CMV effects.
- Emerging evidence highlights significant indirect effects of CMV in this population.
Purpose of the Study:
- To evaluate the indirect effects of cytomegalovirus (CMV) infection in solid organ transplant recipients.
- To identify how these indirect effects impact patient management and outcomes.
- To explore strategies for improving transplant care and reducing resource utilization.
Main Methods:
- Review of recent research on CMV infection in transplant patients.
- Analysis of postulated indirect effects, including opportunistic infections and graft rejection.
- Evaluation of associated increased costs and resource use.
Main Results:
- Prophylactic strategies have successfully decreased direct CMV infection and disease.
- Indirect effects of CMV, such as graft rejection and opportunistic infections, significantly impact outcomes.
- Increased costs and resource utilization are associated with managing these indirect effects.
Conclusions:
- While direct CMV effects are better controlled, indirect CMV impacts remain a critical concern.
- Understanding and addressing indirect CMV effects can lead to improved transplant recipient care.
- Further evaluation of indirect CMV effects may optimize resource use and reduce healthcare costs.