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Clin Transplant. 2019 Feb 28:e13512. doi: 10.1111/ctr.13512. [Epub ahead of print]

Cytomegalovirus in Solid Organ Transplant Recipients - Guidelines of the American Society of Transplantation Infectious Disease Community of Practice.

Author information

1
Mayo Clinic, Rochester, MN.
2
University Health Network, Toronto, Canada.

Abstract

Cytomegalovirus is one of the most common opportunistic infections that affect the outcome of solid organ transplantation. This updated guideline from the American Society of Transplantation Infectious Diseases Community of Practice provides evidence-based and expert recommendations for screening, diagnosis, prevention and treatment of CMV in solid organ transplant recipients. CMV serology to detect immunoglobulin G remains as the standard method for pre-transplant screening of donors and transplant candidates. Antiviral prophylaxis and pre-emptive therapy are the mainstays of CMV prevention. The lack of a widely-applicable viral load threshold for diagnosis and preemptive therapy is highlighted, as a result of variability of CMV nucleic acid testing, even in the contemporary era when calibrators are standardized. Valganciclovir and intravenous ganciclovir remain as drugs of choice for CMV management. Strategies for managing drug-resistant CMV infection are presented. There is increasing use of CMV-specific cell-mediated immune assays to stratify the risk of CMV infection after solid organ transplantation, but their role in optimizing CMV prevention and treatment efforts have yet to be demonstrated. Specific issues related to pediatric transplant recipients are discussed. This article is protected by copyright. All rights reserved.

KEYWORDS:

cidofovir; cytomegalovirus; foscarnet; transplantation; valganciclovir

PMID:
30817026
DOI:
10.1111/ctr.13512

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