Cytomegalovirus antiviral stewardship considerations in solid organ transplant patients

There is a growing acknowledgment of the importance of stewardship initiatives in solid organ transplant given the increased potential for morbidity and mortality. Antiviral stewardship, particularly as it pertains to cytomegalovirus (CMV), has been most extensively studied.

This review outlines the history and development of stewardship interventions in the solid organ transplant population with a focus on antiviral stewardship of CMV. Obstacles and proposed solutions to these obstacles from the vantage point of the UW Health experience are shared. Proposed future applications of the antiviral stewardship framework and structure are discussed. A systematic review of English language studies published since 2000 was performed. Search terms included solid organ transplant, antimicrobial stewardship, antiviral stewardship, post-transplant viral infections, and cytomegalovirus.

Antimicrobial stewardship has a role in the immunocompromised host, and CMV antiviral stewardship is a unique application in solid organ transplant. Utilization of this initiative can improve outcomes related to CMV, particularly in the high-risk population providing a proactive, dedicated effort with a well-established infrastructure for effective surveillance after prophylaxis. Targeted quality improvement initiatives can further personalize the initiative to address issues unique to each transplant center. Large scale or all-encompassing efforts are not required to obtain substantial benefit.