Cytomegalovirus Infection in Liver Transplant Recipients: Current Approach to Diagnosis and Management

Abstract

Cytomegalovirus (CMV) infection is the most common viral infection in liver transplant recipients, affecting post-transplant patients and graft survival. Recent advances in diagnosis and management of CMV have led to marked reduction in incidence, severity, and its associated morbidity and mortality. CMV DNA assay is the most commonly used laboratory parameter to diagnose and monitor CMV infection. Current evidence suggests that both pre-emptive and universal prophylaxis approaches are equally justified in liver transplant recipients. Intravenous ganciclovir and oral valganciclovir are the most commonly used drugs for treatment of CMV disease. Most of the centre use valganciclovir prophylaxis for prevention of CMV disease in liver trasplant recipient. The aim of this article is to review the current standard of care for diagnosis and management of CMV disease in liver transplant recipients.

Keywords: CMV disease; CMV, cytomegalovirus; HCV, hepatitis C virus; HHV, human herpes virus; IV, intravenous; LT, liver transplantation; NAT, nucleic acid test; cytomegalovirus; infection; liver transplantation.

Figure 1

Approach to CMV prophylaxis in adult post liver transplant recipients. *High risk—D+/R− status. Patient receiving steroid pulse therapy or antithymocyte globulin for biopsy-proven rejection ABO-incompatible liver transplant. **Medium risk—or D−/R+ status. Patients who receive bolus steroid on empirical ground for suspected rejection but not in range of steroid pulse therapy. Acute liver failure. Re-transplantation. ***Low risk—D−/R− status. Clinical suspicion of CMV reactivation alone.