When Transplant Goes Viral: The Perils of Overimmunosuppression

Abstract Donor cytomegalovirus (CMV) seropositivity and recipient seronegativivty status and overimmunosuppression are interrelated factors that predispose patients who have undergone transplant to CMV disease. Antiviral prophylaxis is one of the recommended methods of preventing CMV disease in recipients of solid organ transplants. The standard treatment recommendation for CMV disease is intravenous ganciclovir; for mild to moderate cases, oral valganciclovir is appropriate. Foscarnet is the main choice for treating CMV disease due to a UL97-variant virus. Cidofovir is another option for ganciclovir-resistant CMV. Treatment options for drug-resistant CMV are limited. Novel drugs such as maribavir and letermovir are currently under clinical investigation.