Prophylaxis of cytomegalovirus disease in transplant patients

A historical perspective and the epidemiology, pathogenesis, and typical patient presentation of cytomegalovirus (CMV) disease in transplant patients; the implications of clinical trials of prophylactic antiviral drug therapy; and unanswered questions about the optimal duration of prophylaxis and the risk of antiviral drug resistance are discussed.

CMV infection and disease are common in transplant patients. They often are the result of transplantation from a CMV-seropositive donor to a CMV-seronegative recipient or reactivation of latent virus in a CMV-seropositive recipient. Reactivation in transplant recipients may be the result of a blunted cytotoxic T-lymphocyte response and an imbalance in the release of pro-inflammatory and anti-inflammatory cytokines. CMV disease develops in many infected patients and frequently involves the graft. Antiviral drug therapies reduce the risk of and delay the onset of CMV disease in transplant recipients. They also reduce the risk of graft injury.

The optimal duration of antiviral drug prophylaxis in transplant patients remains to be determined; however, it is clear that antiviral prophylaxis can prevent CMV disease as well as many of the complications associated with CMV disease.