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1 March 2008

Volume 46, Number 5
Clinical Infectious Diseases 2008;46:732–740
© 2008 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2008/4605-0014$15.00
DOI: 10.1086/527397
VIEWPOINTS

Improving Outcomes for Solid‐Organ Transplant Recipients At Risk from Cytomegalovirus Infection: Late‐Onset Disease and Indirect Consequences

Christophe Legendre1 and

Manuel Pascual2

1Service de Transplantation Rénale, Hôpital Necker, Paris, France; and 2Transplantation Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Cytomegalovirus (CMV) is one of the most important pathogens following solid‐organ transplantation, and effective prevention of CMV infection is a priority. The long‐term control of CMV infection is dependent, in part, on the development of CMV‐specific T cells, and controversy exists regarding whether CMV prophylaxis may prevent this. Although preemptive therapy is beneficial for the prevention of CMV disease, monitoring of viral levels in the blood does not always reflect what is occurring in tissues. Persistent low‐level CMV infection has been associated with indirect consequences, such as transplant‐associated vasculopathy, posttransplantation diabetes, an increased risk of opportunistic infection, and graft rejection. The issues surrounding preventive strategies for CMV disease following solid‐organ transplantation are reviewed. We argue that prophylaxis is more effective than preemptive therapy; extending the duration of prophylaxis to the period of less intense immunosuppression could protect patients from late‐onset disease, as well as from the indirect effects of CMV infection.

Received 8 June 2007; accepted 24 October 2007; electronically published 23 January 2008.

Reprints or correspondence: Dr. Christophe Legendre, Service de Transplantation Rénale, Hôpital Necker, 149 rue de Sèvres, 75015 Paris, France ().

Cited by

Frédéric Lamoth, Oriol Manuel, Jean-Pierre Venetz, Mohamed Faouzi, Pascal Meylan, Manuel Pascual. (2008) What Is the Impact of Late-Onset Cytomegalovirus Disease After Valganciclovir Prophylaxis in Kidney Transplantation?. Transplantation 86:9, 1323-1324
Online publication date: 1-Dec-2008.
CrossRef
Mark D Pescovitz. (2008) Maribavir: a new oral anti-cytomegalovirus drug. Future Virology 3:5, 435-443
Online publication date: 1-Oct-2008.
CrossRef
Maria-Luisa Alegre, Daniel R Goldstein, Anita S Chong. (2008) Toll-like receptor signaling in transplantation. Current Opinion in Organ Transplantation 13:4, 358-365
Online publication date: 1-Sep-2008.
CrossRef
Nina Singh. (2008) Optimal Prevention of Late‐Onset Cytomegalovirus (CMV) Disease and Other Sequelae of CMV Infection in Organ Transplant Recipients. Clinical Infectious Diseases 47:2, 296-297
Online publication date: 15-Jul-2008.
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