Management of cytomegalovirus infection after liver transplantation

Abstract

Cytomegalovirus (CMV) infection is one of the primary causes of morbidity and mortality following liver transplantation (LT). Based on current worldwide guidelines, the most effective strategies for avoiding post-transplant CMV infection are antiviral prophylaxis and pre-emptive treatment. CMV- IgG serology is the established technique for pretransplant screening of both donors and recipients. The clinical presentation of CMV infection and disease exhibits variability, prompting clinicians to consistently consider this possibility, particularly within the first year post-transplantation or subsequent to heightened immunosuppression. At annual symposia to discuss CMV prevention and how treatment outcomes can be improved, evidence on the incorporation of immune functional tests into clinical practice is presented, and the results of studies with new antiviral treatments are evaluated. Although there are ongoing studies on the use of letermovir and maribavir in solid organ transplantation, a consensus reflected in the guidelines has not been formed. Determining the most appropriate strategy at the individual level appears to be the key to enhancing outcomes. Although prevention strategies reduce the risk of CMV disease, the disease can still occur in up to 50% of high-risk patients. A balance between the risk of infection and disease development and the use of immunosuppressants must be considered when talking about the proper management of CMV in solid organ transplant recipients. The objective of this study was to establish a comprehensive framework for the management of CMV in patients who have had LT.

Keywords: Liver transplantation; Cytomegalovirus; Antiviral prophylaxis; Preemptive treatment; Valganciclovir; Ganciclovir

Core tip: Cytomegalovirus (CMV) is a significant factor in the development of opportunistic infection complications following liver transplantation. Antiviral prophylaxis and pre-emptive treatment are the most effective approaches for preventing post-transplant CMV infection, as stated by current worldwide standards. CMV-IgG serology is still the standard method for screening both donors and recipients prior to transplantation. When discussing the appropriate management of CMV in solid organ transplant recipients, it is important to examine the balance between the use of immunosuppressants and the risk of infection and disease progression.