Copyright ©2014 Baishideng Publishing Group Inc.
World J Hepatol. Jun 27, 2014; 6(6): 370-383
Published online Jun 27, 2014. doi: 10.4254/wjh.v6.i6.370
Table 1 Direct and indirect clinical effects of cytomegalovirus after liver transplantation
Direct effectsIndirect effects
CMV syndromeAcute allograft rejection
FeverChronic allograft rejection
MyelosuppressionVanishing bile duct syndrome
MalaiseChronic ductopenic rejection
Tissue-invasive CMV disease1Hepatitis C virus recurrence
Gastrointestinal diseaseAllograft hepatitis, fibrosis
(colitis, esophagitis, gastritis,Allograft failure
enteritis)Opportunistic and other infections
HepatitisFungal superinfection
CNS diseaseBacterial superinfection
RetinitisEpstein-Barr virus and PTLD
MortalityHHV-6 and HHV-7 infections
Vascular thrombosis
New onset diabetes mellitus
Table 2 Estimated incidence of cytomegalovirus disease during the first 12 mo after liver transplantation
Use of anti-CMV prophylaxis for 3-6 mo
CMV D+/R-12%-30%44%-65%
CMV D+/R+2.70%18.20%
CMV D-/R+3.90%7.90%
CMV D-/R-0%1%-2%
All patients4.80%18%-29%
Table 3 Actors associated with increased risk of cytomegalovirus disease after liver transplantation
CMV D+/R- > CMV R+
Allograft rejection
High viral replication
Mycophenolate mofetil
Anti-thymocyte globulin
Human herpesvirus-6
Human herpesvirus-7
Renal insufficiency
Deficiency in CMV-specific CD4+ T cells
Deficiency in CMV-specific CD8+ T cells
Toll-like receptor gene polymorphism
Mannose binding lectin deficiency
Chemokine and cytokine defects (IL-10, MCP-1, CCR5)
Expression of immune evasion genes
Programmed cell death 1 expression
Table 4 Currently available antiviral drugs for cytomegalovirus prophylaxis and treatment in liver transplant recipients
DrugRouteUsual adult prophylaxis doseUsual adult treatment doseComments on use and major toxicity
GanciclovirIntravenous5 mg/kg once daily5 mg/kg twice dailyIntravenous access; leukopenia
GanciclovirOral1 g three times dailyNot applicableLow oral bioavailability; high pill burden
ValganciclovirOral900 mg once daily900 mg twice dailyEase of administration; leukopenia
FoscarnetIntravenousNot recommended60 mg/kg every 8 h (or 90 mg/kg every 12 h)Second-line drug Intravenous access; nephrotoxicity
CidofovirIntravenousNot recommended5 mg/kg once weekly × 2 then every 2 wk thereafterThird-line drug Intravenous access; nephrotoxicity