Yilmaz ZB, Memisoglu F, Akbulut S. Management of cytomegalovirus infection after liver transplantation. World J Transplant 2024; 14(3): 93209 [DOI: 10.5500/wjt.v14.i3.93209]
Corresponding Author of This Article
Sami Akbulut, FACS, FICS, MD, PhD, Professor, Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 10 Elazig Yolu Km, Malatya 44280, Türkiye. akbulutsami@gmail.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Sep 18, 2024; 14(3): 93209 Published online Sep 18, 2024. doi: 10.5500/wjt.v14.i3.93209
Management of cytomegalovirus infection after liver transplantation
Zeynep Burcin Yilmaz, Funda Memisoglu, Sami Akbulut
Zeynep Burcin Yilmaz, Funda Memisoglu, Infectious Diseases and Clinical Microbiology, Inonu University Faculty of Medicine, Malatya 44280, Türkiye
Sami Akbulut, Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Türkiye
Author contributions: Yilmaz ZB and Akbulut S performed the majority of the writing and prepared the tables; Yilmaz ZB and Memisoglu F performed data accusation and writing; Yilmaz ZB, Memisoglu F, and Akbulut S designed the outline and coordinated the writing of the paper.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sami Akbulut, FACS, FICS, MD, PhD, Professor, Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 10 Elazig Yolu Km, Malatya 44280, Türkiye. akbulutsami@gmail.com
Received: February 21, 2024 Revised: May 5, 2024 Accepted: May 27, 2024 Published online: September 18, 2024 Processing time: 160 Days and 10.5 Hours
Abstract
Cytomegalovirus (CMV) infection is one of the primary causes of morbidity and mortality following liver transplantation (LT). Based on current worldwide guidelines, the most effective strategies for avoiding post-transplant CMV infection are antiviral prophylaxis and pre-emptive treatment. CMV- IgG serology is the established technique for pretransplant screening of both donors and recipients. The clinical presentation of CMV infection and disease exhibits variability, prompting clinicians to consistently consider this possibility, particularly within the first year post-transplantation or subsequent to heightened immunosuppression. At annual symposia to discuss CMV prevention and how treatment outcomes can be improved, evidence on the incorporation of immune functional tests into clinical practice is presented, and the results of studies with new antiviral treatments are evaluated. Although there are ongoing studies on the use of letermovir and maribavir in solid organ transplantation, a consensus reflected in the guidelines has not been formed. Determining the most appropriate strategy at the individual level appears to be the key to enhancing outcomes. Although prevention strategies reduce the risk of CMV disease, the disease can still occur in up to 50% of high-risk patients. A balance between the risk of infection and disease development and the use of immunosuppressants must be considered when talking about the proper management of CMV in solid organ transplant recipients. The objective of this study was to establish a comprehensive framework for the management of CMV in patients who have had LT.
Core tip: Cytomegalovirus (CMV) is a significant factor in the development of opportunistic infection complications following liver transplantation. Antiviral prophylaxis and pre-emptive treatment are the most effective approaches for preventing post-transplant CMV infection, as stated by current worldwide standards. CMV-IgG serology is still the standard method for screening both donors and recipients prior to transplantation. When discussing the appropriate management of CMV in solid organ transplant recipients, it is important to examine the balance between the use of immunosuppressants and the risk of infection and disease progression.
