CMV after solid organ transplantation
From IDWiki
Management
- Two approaches are used, either ongoing antimicrobial prophylaxis following transplantation, or close monitoring of viral load with preemptive treatment (PET) of subclinical viremia
- Approach and duration depends on risk profile and organ transplanted
- Intermediate and high risk patients should get either prophylaxis or PET
- Prophylaxis (rather than PET) is preferred in lung, heart, and pancreas transplantations
- Low risk should either be monitored for symptoms or be followed with PET (if there is other concern for CMV disease, such as frequent transfusions)
- Intermediate and high risk patients should get either prophylaxis or PET
- Antimicrobial of choice is valganciclovir 900 mg po daily, starting within 10 days of transplantation
| Serostatus | Risk profile | Approach | Prophylaxis regimen |
|---|---|---|---|
| D+/R- | High | Either prophylaxis or PET; prophylaxis preferred for lung, heart, and pancreas | 3-6 months for most organs; 6 months for kidney; 6-12 months for lung |
| R+ | Intermediate | Either prophylaxis or PET; prophylaxis preferred for lung, heart, and pancreas | 3 months for most organs; 6 months for lung |
| D-/R- | Low | Clinical monitoring; consider PET if other risk factors for CMV |
Further Reading
- The Third International Consensus Guidelines on the Management of Cytomegalovirus in Solid-organ Transplantation. Transplantation. 2018;102:900–931. DOI: 10.1097/TP.0000000000002191
