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

J Clin Virol. 2006 Apr;35(4):474-7. doi: 10.1016/j.jcv.2005.10.014. Epub 2006 Jan 6.


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.

MeSH terms

  • Antiviral Agents / therapeutic use*
  • Chemoprevention
  • Cytomegalovirus Infections / prevention & control*
  • Cytomegalovirus Infections / virology
  • Humans
  • Organ Transplantation / adverse effects*


  • Antiviral Agents