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World J Gastroenterol. Aug 21, 2014; 20(31): 10658-10667
Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10658
Cytomegalovirus infection in liver transplant recipients: Updates on clinical management
Jasmine Riviere Marcelin, Elena Beam, Raymund R Razonable
Jasmine Riviere Marcelin, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
Elena Beam, Raymund R Razonable, Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
Raymund R Razonable, William Jvon Leibig Transplant Center, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Marcelin JR conducted the initial literature review and analysis, writing of initial draft and subsequent manuscript revisions; Beam E and Razonable RR contributed subsequent drafts and manuscript revision; all authors participated in critical review and approval of final version of manuscript.
Correspondence to: Raymund R Razonable, MD, Division of Infectious Diseases, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. razonable.raymund@mayo.edu
Telephone: +1-507-2843747 Fax: +1-507-2557767
Received: November 12, 2013
Revised: January 24, 2014
Accepted: April 2, 2014
Published online: August 21, 2014
Processing time: 281 Days and 17.9 Hours
Abstract

Cytomegalovirus (CMV) infection is a common complication after liver transplantation, and it is associated with multiple direct and indirect effects. Management of CMV infection and disease has evolved over the years, and clinical guidelines have been recently updated. Universal antiviral prophylaxis and a pre-emptive treatment strategy are options for prevention. A currently-recruiting randomized clinical trial is comparing the efficacy and safety of the two prevention strategies in the highest risk D+R- liver recipients. Drug-resistant CMV infection remains uncommon but is now increasing in incidence. This highlights the currently limited therapeutic options, and the need for novel drug discoveries. Immunotherapy and antiviral drugs with novel mechanisms of action are being investigated, including letermovir (AIC246) and brincidofovir (CMX001). This article reviews the current state of CMV management after liver transplantation, including the updated practice guidelines, and summarizes the data on investigational drugs and vaccines in clinical development.

Keywords: Cytomegalovirus; Liver transplantation; Valganciclovir; Prophylaxis; Treatment; Resistance; Investigational; Letermovir; Brincidofovir

Core tip: In this article, the authors review the current literature of cytomegalovirus (CMV) infection after liver transplantation, including the approaches to diagnosis, prevention and treatment. The review highlights the pros and cons of the prophylaxis vs pre-emptive prevention strategies, especially in the highest risk D+/R- population. Treatment of CMV infection in liver transplant patients is discussed in addition to management of CMV resistance, with detailed discussion of recently updated clinical CMV management guidelines. Finally, the future management of CMV in liver transplant recipients relies on new drug discoveries, and the authors describe multiple investigational drugs and vaccines in clinical trials.