Management of cytomegalovirus infection in solid organ transplantation

Cytomegalovirus (CMV) infections are among the most common infections that occur following solid organ transplantation. CMV disease ranges from asymptomatic viremia, to CMV syndrome, to tissue-invasive disease. As CMV prophylaxis, treatment, diagnostics, and overall awareness have improved, the general trend has been towards earlier diagnosis of CMV disease and more mild clinical presentations in solid organ transplant recipients. Major stumbling blocks remain in the areas of duration of prophylaxis for the individual recipient, in the identification of which patients might need secondary prophylaxis, in the treatment of resistant virus, and in the possible use of the adoptive transfer of CMV-specific T cells. Several guidelines have been published during the past few years regarding the management of CMV in solid organ transplant recipients. This Review covers CMV diagnostics, methods for the prevention of CMV infection, treatment of both regular and drug-resistant CMV, as well as future directions for CMV management and research.