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J Clin Virol. 2006 Apr;35(4):474-7. Epub 2006 Jan 6.

Cytomegalovirus infection in solid organ transplant recipients: new challenges and their implications for preventive strategies.

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1
VA Medical Center and University of Pittsburgh, Infectious Disease Section, University Drive C, Pittsburgh, PA 15240, USA. nis5+@pitt.edu

Abstract

BACKGROUND:

Late-onset CMV disease is being increasingly recognized as a significant post-transplantation complication.

OBJECTIVES:

To discern the impact of antiviral prophylactic strategies on the emerging syndrome of late-onset CMV disease in organ transplant recipients.

STUDY DESIGN:

Review of existing reports and published data relevant to antiviral prophylaxis in organ transplant recipients.

RESULTS:

Prevention of CMV using prophylaxis has proven effective and is widely employed in organ transplant recipients. However, late-onset CMV disease is increasingly being recognized as a significant complication in these patients. The more potent the activity of the antiviral drug and the longer duration of prophylaxis, the greater likelihood of late-onset CMV disease. CMV seronegative recipients of seropositive donor allografts appear to be at a uniquely high risk. A higher proportion of patients with late-onset CMV have tissue invasive disease. Late-onset CMV disease in liver transplant recipients conferred an independently higher risk of mortality in the first post-transplant year. Prolonged antiviral therapy may impair the recovery of CMV-specific T-cell responses. Preemptive therapy appears to be less likely to be associated with CMV disease.

CONCLUSIONS:

Discernment of the pathophysiologic basis of late-onset CMV warrants investigation. Preemptive therapy may be the preferable approach to CMV prophylaxis.

PMID:
16406798
DOI:
10.1016/j.jcv.2005.10.014
[Indexed for MEDLINE]
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