Tackling CMV in Transplant Recipients: Past, Present, and Future

Area of Science:

• Virology
• Immunology
• Transplantation Medicine

Background:

• Cytomegalovirus (CMV) is a lifelong latent beta-herpesvirus with significant risks for transplant recipients.
• Management has shifted from reactive to proactive, preventive strategies to mitigate CMV-related morbidity and mortality.

Purpose of the Study:

• To review recent advances in CMV prevention and treatment for transplant recipients.
• To discuss the role of novel agents like letermovir and maribavir.
• To explore the potential of immune monitoring for personalized prophylaxis strategies.

Main Methods:

• Review of current literature on CMV prophylaxis and treatment in transplantation.
• Analysis of the efficacy and safety profiles of letermovir and maribavir.
• Discussion of emerging diagnostic tools, including interferon-gamma release assays.

Main Results:

• Letermovir and maribavir represent significant advancements in CMV prophylaxis and treatment, respectively.
• Late-onset CMV infection post-prophylaxis remains a challenge.
• Immune monitoring assays show promise in guiding prophylaxis decisions.

Conclusions:

• Novel antivirals and immune-based diagnostics are transforming CMV management in transplant recipients.
• Personalized approaches based on immune competence are the future of CMV care.
• Continued innovation is crucial for reducing CMV complications and improving transplant outcomes.