Cytomegalovirus (CMV) is an enveloped double-stranded DNA virus, that in the healthy population, causes a mild flu-like illness. CMV is the most common, opportunistic viral pathogen in the solid organ transplant (SOT) setting and is associated with considerable morbidity, mortality, and graft loss. CMV causes lifelong infection, and organs from seropositive donors may transmit infection, potentially causing severe disease in a seronegative patient undergoing solid organ transplantation.
Donor and recipient CMV IgG serological screening is utilised to stratify the risk of post-transplant CMV infection. The serostatus of both the donor and the recipients are key predictors of the risk of CMV after transplant and guide decisions on antiviral prophylaxis or pre-emptive treatment strategies.
In SOT recipients, CMV can occur as a primary infection, donor-derived infection, or because of reactivation of latent virus in the setting of immunosuppression.
Anti-viral prophylaxis and pre-emptive therapy are the main approaches for prevention of CMV in the SOT population. Valganciclovir and intravenous Ganciclovir remain drugs of choice for CMV management in all consensus guidelines. Currently, there is no prophylactic vaccine available.
