Management of CMV infection and disease in transplant patients

Raymund R. Razonable, Vincent C. Emery

Research output: Contribution to journalArticle

133 Scopus citations

Abstract

The International Herpes Management Forum (IHMF®) has published guidelines for the diagnosis and management of cytomegalovirus (CMV) infection and disease in solid organ (SOT) and haematopoietic stem cell transplant (HSCT) recipients. These recommendations have been updated to include, among others: (1) use of whole blood for the polymerase chain reaction (PCR) diagnosis of CMV infection; (2) CMV load measurements for prognostication and for monitoring response to anti-CMV therapy; (3) valganciclovir prophylaxis in CMV donor-positive/recipient-negative (D+/R-) SOT patients for prevention of CMV disease; (4) oral ganciclovir prophylaxis, in preference to aciclovir, to reduce incidence of CMV disease in SOT patients; (5) pre-emptive therapy with oral ganciclovir to reduce incidence of CMV disease and viraemia in liver transplant patients; (6) valaciclovir prophylaxis, in preference to high-dose oral aciclovir, to prevent CMV infection in allogeneic HSCT patients; and (7) foscarnet as an alternative to intravenous ganciclovir for pre-emptive treatment of CMV infection in allogeneic HSCT patients. New developments in the field requiring further research were highlighted, including: optimal frequency of CMV monitoring in CMV D+/R- SOT patients; optimal duration of prophylaxis for the prevention of late CMV disease; need for an acceptable viral threshold for initiation of pre-emptive therapy; and assessment of the clinical efficacy of valganciclovir for the treatment of CMV disease and as pre-emptive therapy in SOT and HSCT patients. This article presents supporting evidence for these recommendations and statements.

Original languageEnglish (US)
Pages (from-to)77-86
Number of pages10
JournalHerpes
Volume11
Issue number3
StatePublished - Dec 1 2004

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Keywords

  • Bone marrow transplant
  • Cytomegalovirus
  • Guidelines
  • Haematopoietic stem cell transplant
  • Recommendations
  • Solid organ transplant
  • Valganciclovir

ASJC Scopus subject areas

  • Infectious Diseases

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