Cytomegalovirus infection and disease in liver transplant recipients

Symptomatic cytomegalovirus (CMV) infection occurs in 25% of patients following liver transplantation. The most common organ-specific manifestation is CMV hepatitis, and the mainstay of treatment is intravenous ganciclovir. Intravenous and oral ganciclovir and immune globulins are useful for CMV prophylaxis. Patients receiving OKT3 monoclonal antibodies for the treatment of rejection should be given secondary ganciclovir prophylaxis because of the high risk of viral reactivation. Pre-emptive intravenous ganciclovir based on surveillance cultures has also been shown to be an effective approach. The polymerase chain reaction and antigenaemia are being studied as markers of future CMV disease, and thus may be of use in the future to trigger pre-emptive therapy. Future efforts will focus on fine-tuning the prevention of CMV infection and disease in liver transplant recipients.