Cytomegalovirus infection after liver transplantation: Epidemiology, risk factors, and management

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Cytomegalovirus (CMV) is the most common viral infection that causes clinical disease after liver transplantation. CMV infection in liver transplant recipients can either be asymptomatic or can manifest clinically as fever with myelosuppression (termed CMV syndrome) or as tissue invasive CMV diseases that could involved the gastrointestinal tract, lungs, and the liver allograft. The most common risk factor for CMV disease after liver transplantation is the lack of CMV-specific immunity. In particular, CMV-seronegative recipients of liver allograft from CMV-seropositive donors (D+/R- mismatch) are considered at highest risk. Severe impairment in cell-mediated immunity from the use of lymphocyte-depleting drugs further augments the risk. In addition to its direct effects, CMV can increase the risk of other clinically relevant indirect effects such rejection, opportunistic infections, and mortality. Prevention of CMV infection and disease is of utmost importance after liver transplantation. In this regard, prevention of CMV disease can be achieved either with preemptive therapy (antiviral therapy is administered only in the presence of a positive CMV PCR or pp65 antigenemia) or antiviral prophylaxis (antiviral drug is administered to all patients at risk of CMV disease). Both approaches are similarly effective in preventing CMV disease, although antiviral prophylaxis is preferred for the highest risk liver transplant recipients. Treatment of CMV disease consists of intravenous ganciclovir (for severe disease) or oral valganciclovir (for mild to moderate CMV disease), and the duration of treatment should be guided by clinical and virologic monitoring. CMV resistance is an emerging concern after solid organ transplantation, although it remains rare after liver transplantation.

Original languageEnglish (US)
Title of host publicationCytomegalovirus Infections: Risk Factors, Causes and Management
PublisherNova Science Publishers, Inc.
Pages221-236
Number of pages16
ISBN (Print)9781619422216
StatePublished - 2012

Fingerprint

Cytomegalovirus Infections
Risk Management
Cytomegalovirus
Liver Transplantation
Epidemiology
Antiviral Agents
Liver
Allografts
Ganciclovir
Opportunistic Infections
Organ Transplantation
Virus Diseases
Therapeutics
Cellular Immunity
Gastrointestinal Tract
Immunity

Keywords

  • Cytomegalovirus
  • Outcome
  • Prophylaxis
  • Therapy
  • Transplantation

ASJC Scopus subject areas

  • Medicine(all)
  • Immunology and Microbiology(all)

Cite this

Razonable, R. R. (2012). Cytomegalovirus infection after liver transplantation: Epidemiology, risk factors, and management. In Cytomegalovirus Infections: Risk Factors, Causes and Management (pp. 221-236). Nova Science Publishers, Inc..

Cytomegalovirus infection after liver transplantation : Epidemiology, risk factors, and management. / Razonable, Raymund R.

Cytomegalovirus Infections: Risk Factors, Causes and Management. Nova Science Publishers, Inc., 2012. p. 221-236.

Research output: Chapter in Book/Report/Conference proceedingChapter

Razonable, RR 2012, Cytomegalovirus infection after liver transplantation: Epidemiology, risk factors, and management. in Cytomegalovirus Infections: Risk Factors, Causes and Management. Nova Science Publishers, Inc., pp. 221-236.
Razonable RR. Cytomegalovirus infection after liver transplantation: Epidemiology, risk factors, and management. In Cytomegalovirus Infections: Risk Factors, Causes and Management. Nova Science Publishers, Inc. 2012. p. 221-236
Razonable, Raymund R. / Cytomegalovirus infection after liver transplantation : Epidemiology, risk factors, and management. Cytomegalovirus Infections: Risk Factors, Causes and Management. Nova Science Publishers, Inc., 2012. pp. 221-236
@inbook{531c8d55e4aa421499b4c21a14df9b50,
title = "Cytomegalovirus infection after liver transplantation: Epidemiology, risk factors, and management",
abstract = "Cytomegalovirus (CMV) is the most common viral infection that causes clinical disease after liver transplantation. CMV infection in liver transplant recipients can either be asymptomatic or can manifest clinically as fever with myelosuppression (termed CMV syndrome) or as tissue invasive CMV diseases that could involved the gastrointestinal tract, lungs, and the liver allograft. The most common risk factor for CMV disease after liver transplantation is the lack of CMV-specific immunity. In particular, CMV-seronegative recipients of liver allograft from CMV-seropositive donors (D+/R- mismatch) are considered at highest risk. Severe impairment in cell-mediated immunity from the use of lymphocyte-depleting drugs further augments the risk. In addition to its direct effects, CMV can increase the risk of other clinically relevant indirect effects such rejection, opportunistic infections, and mortality. Prevention of CMV infection and disease is of utmost importance after liver transplantation. In this regard, prevention of CMV disease can be achieved either with preemptive therapy (antiviral therapy is administered only in the presence of a positive CMV PCR or pp65 antigenemia) or antiviral prophylaxis (antiviral drug is administered to all patients at risk of CMV disease). Both approaches are similarly effective in preventing CMV disease, although antiviral prophylaxis is preferred for the highest risk liver transplant recipients. Treatment of CMV disease consists of intravenous ganciclovir (for severe disease) or oral valganciclovir (for mild to moderate CMV disease), and the duration of treatment should be guided by clinical and virologic monitoring. CMV resistance is an emerging concern after solid organ transplantation, although it remains rare after liver transplantation.",
keywords = "Cytomegalovirus, Outcome, Prophylaxis, Therapy, Transplantation",
author = "Razonable, {Raymund R}",
year = "2012",
language = "English (US)",
isbn = "9781619422216",
pages = "221--236",
booktitle = "Cytomegalovirus Infections: Risk Factors, Causes and Management",
publisher = "Nova Science Publishers, Inc.",

}

TY - CHAP

T1 - Cytomegalovirus infection after liver transplantation

T2 - Epidemiology, risk factors, and management

AU - Razonable, Raymund R

PY - 2012

Y1 - 2012

N2 - Cytomegalovirus (CMV) is the most common viral infection that causes clinical disease after liver transplantation. CMV infection in liver transplant recipients can either be asymptomatic or can manifest clinically as fever with myelosuppression (termed CMV syndrome) or as tissue invasive CMV diseases that could involved the gastrointestinal tract, lungs, and the liver allograft. The most common risk factor for CMV disease after liver transplantation is the lack of CMV-specific immunity. In particular, CMV-seronegative recipients of liver allograft from CMV-seropositive donors (D+/R- mismatch) are considered at highest risk. Severe impairment in cell-mediated immunity from the use of lymphocyte-depleting drugs further augments the risk. In addition to its direct effects, CMV can increase the risk of other clinically relevant indirect effects such rejection, opportunistic infections, and mortality. Prevention of CMV infection and disease is of utmost importance after liver transplantation. In this regard, prevention of CMV disease can be achieved either with preemptive therapy (antiviral therapy is administered only in the presence of a positive CMV PCR or pp65 antigenemia) or antiviral prophylaxis (antiviral drug is administered to all patients at risk of CMV disease). Both approaches are similarly effective in preventing CMV disease, although antiviral prophylaxis is preferred for the highest risk liver transplant recipients. Treatment of CMV disease consists of intravenous ganciclovir (for severe disease) or oral valganciclovir (for mild to moderate CMV disease), and the duration of treatment should be guided by clinical and virologic monitoring. CMV resistance is an emerging concern after solid organ transplantation, although it remains rare after liver transplantation.

AB - Cytomegalovirus (CMV) is the most common viral infection that causes clinical disease after liver transplantation. CMV infection in liver transplant recipients can either be asymptomatic or can manifest clinically as fever with myelosuppression (termed CMV syndrome) or as tissue invasive CMV diseases that could involved the gastrointestinal tract, lungs, and the liver allograft. The most common risk factor for CMV disease after liver transplantation is the lack of CMV-specific immunity. In particular, CMV-seronegative recipients of liver allograft from CMV-seropositive donors (D+/R- mismatch) are considered at highest risk. Severe impairment in cell-mediated immunity from the use of lymphocyte-depleting drugs further augments the risk. In addition to its direct effects, CMV can increase the risk of other clinically relevant indirect effects such rejection, opportunistic infections, and mortality. Prevention of CMV infection and disease is of utmost importance after liver transplantation. In this regard, prevention of CMV disease can be achieved either with preemptive therapy (antiviral therapy is administered only in the presence of a positive CMV PCR or pp65 antigenemia) or antiviral prophylaxis (antiviral drug is administered to all patients at risk of CMV disease). Both approaches are similarly effective in preventing CMV disease, although antiviral prophylaxis is preferred for the highest risk liver transplant recipients. Treatment of CMV disease consists of intravenous ganciclovir (for severe disease) or oral valganciclovir (for mild to moderate CMV disease), and the duration of treatment should be guided by clinical and virologic monitoring. CMV resistance is an emerging concern after solid organ transplantation, although it remains rare after liver transplantation.

KW - Cytomegalovirus

KW - Outcome

KW - Prophylaxis

KW - Therapy

KW - Transplantation

UR - http://www.scopus.com/inward/record.url?scp=84892910587&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84892910587&partnerID=8YFLogxK

M3 - Chapter

AN - SCOPUS:84892910587

SN - 9781619422216

SP - 221

EP - 236

BT - Cytomegalovirus Infections: Risk Factors, Causes and Management

PB - Nova Science Publishers, Inc.

ER -