Preventing Cytomegalovirus Infection After Liver Transplant: An Evolving Approach

Despite recent advances in the management of patients following liver transplant, cytomegalovirus (CMV) infection remains a substantial cause of morbidity and mortality among this population. Clinicians and transplant centers have adopted varying approaches to managing CMV-seronegative liver transplant recipients with CMV-seropositive donors, a recipient group that is at highest risk for developing CMV-associated complications. Antiviral prophylaxis is typically initiated soon after transplant for a period of several months. Although the most widely used strategy, prophylaxis is limited by the incidence of delayed-onset CMV disease that can occur long after antivirals are completed. In contrast, preemptive therapy involves monitoring patients for CMV viremia and beginning antivirals only after CMV replication is detected by polymerase chain reaction testing. Small, observational studies have suggested that preemptive therapy in this high-risk population may be associated with lower rates of CMV disease.
Source: JAMA - Category: General Medicine Source Type: research