Prevention and Management of CMV Infections after Liver Transplantation: Current Practice in German Transplant Centers

Cornelius Engelmann^{1

2

3}, Martina Sterneck⁴, Karl Heinz Weiss⁵, Silke Templin⁶, Steffen Zopf⁷, Gerald Denk^{8

9}, Dennis Eurich¹⁰, Johann Pratschke¹⁰, Johannes Weiss¹¹, Felix Braun¹², Martin-Walter Welker¹³, Tim Zimmermann¹⁴, Petra Knipper¹⁵, Dirk Nierhoff¹⁶, Thomas Lorf¹⁷, Elmar Jäckel¹⁸, Hans-Michael Hau¹⁹, Tung Yu Tsui²⁰, Aristoteles Perrakis²¹, Hans-Jürgen Schlitt²², Kerstin Herzer²³, Frank Tacke^{1

24}

Affiliations

¹ Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum, Charité University Medicine Berlin, 13353 Berlin, Germany.
² Institute for Liver and Digestive Health, University College London, Royal Free Campus, London NW32PF, UK.
³ Section Hepatology, Clinic for Gastroenterology and Rheumatology, University Hospital Leipzig, 04103 Leipzig, Germany.
⁴ Department of Medicine I, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany.
⁵ Department of Gastroenterology and Hepatology, University of Heidelberg, 69117 Heidelberg, Germany.
⁶ Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, 72076 Tübingen, Germany.
⁷ Department of Medicine 1, University of Erlangen-Nürnberg, 91054 Erlangen, Germany.
⁸ Medical clinic and policlinic II, Campus Grosshadern, Ludwig Maximilians University (LMU), 80333 Munich, Germany.
⁹ Transplantation Center Munich, University Hospital, 81377 LMU Munich, Germany.
¹⁰ Department of Surgery Campus Charité Mitte/Campus Virchow-Klinikum, 13353 Berlin, Germany.
¹¹ Department of Medicine II, University Hospital Würzburg, 97080 Würzburg, Germany.
¹² Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany.
¹³ Department of Medicine I, University Hospital Frankfurt, 60590 Frankfurt, Germany.
¹⁴ Department of Medicine, Hepatology, University of Mainz, 55101 Mainz, Germany.
¹⁵ Department of Internal Medicine I, University Hospital Bonn, 53127 Bonn, Germany.
¹⁶ Department of Gastroenterology and Hepatology, University Hospital Köln, 50937 Köln, Germany.
¹⁷ Clinic for General, Visceral and Pediatric Surgery, University Medical Center Goettingen, 37075 Goettingen, Germany.
¹⁸ Department of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, 30625 Hannover, Germany.
¹⁹ Department of Visceral, Transplantation, Thoracic, and Vascular Surgery, University Hospital Leipzig, 04103 Leipzig, Germany.
²⁰ Section of Oncological Surgery and Transplantation, Rostock University Medical Center, 18057 Rostock, Germany.
²¹ Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany.
²² Department of Surgery, University of Regensburg, 93053 Regensburg, Germany.
²³ Knappschafts-Hospital Bad Neuenahr, Deutsche Rentenversicherung, Knappschaft-Bahn-See, 53474 Bad Neuenahr-Ahrweiler, Germany.
²⁴ Department of Medicine III, University Hospital Aachen, 52074 Aachen, Germany.

PMID: 32717978
PMCID: PMC7465768
DOI: 10.3390/jcm9082352

Prevention and Management of CMV Infections after Liver Transplantation: Current Practice in German Transplant Centers

Cornelius Engelmann et al. J Clin Med. 2020.

. 2020 Jul 23;9(8):2352.

doi: 10.3390/jcm9082352.

Authors

Affiliations

¹ Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum, Charité University Medicine Berlin, 13353 Berlin, Germany.
² Institute for Liver and Digestive Health, University College London, Royal Free Campus, London NW32PF, UK.
³ Section Hepatology, Clinic for Gastroenterology and Rheumatology, University Hospital Leipzig, 04103 Leipzig, Germany.
⁴ Department of Medicine I, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany.
⁵ Department of Gastroenterology and Hepatology, University of Heidelberg, 69117 Heidelberg, Germany.
⁶ Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, 72076 Tübingen, Germany.
⁷ Department of Medicine 1, University of Erlangen-Nürnberg, 91054 Erlangen, Germany.
⁸ Medical clinic and policlinic II, Campus Grosshadern, Ludwig Maximilians University (LMU), 80333 Munich, Germany.
⁹ Transplantation Center Munich, University Hospital, 81377 LMU Munich, Germany.
¹⁰ Department of Surgery Campus Charité Mitte/Campus Virchow-Klinikum, 13353 Berlin, Germany.
¹¹ Department of Medicine II, University Hospital Würzburg, 97080 Würzburg, Germany.
¹² Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany.
¹³ Department of Medicine I, University Hospital Frankfurt, 60590 Frankfurt, Germany.
¹⁴ Department of Medicine, Hepatology, University of Mainz, 55101 Mainz, Germany.
¹⁵ Department of Internal Medicine I, University Hospital Bonn, 53127 Bonn, Germany.
¹⁶ Department of Gastroenterology and Hepatology, University Hospital Köln, 50937 Köln, Germany.
¹⁷ Clinic for General, Visceral and Pediatric Surgery, University Medical Center Goettingen, 37075 Goettingen, Germany.
¹⁸ Department of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, 30625 Hannover, Germany.
¹⁹ Department of Visceral, Transplantation, Thoracic, and Vascular Surgery, University Hospital Leipzig, 04103 Leipzig, Germany.
²⁰ Section of Oncological Surgery and Transplantation, Rostock University Medical Center, 18057 Rostock, Germany.
²¹ Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany.
²² Department of Surgery, University of Regensburg, 93053 Regensburg, Germany.
²³ Knappschafts-Hospital Bad Neuenahr, Deutsche Rentenversicherung, Knappschaft-Bahn-See, 53474 Bad Neuenahr-Ahrweiler, Germany.
²⁴ Department of Medicine III, University Hospital Aachen, 52074 Aachen, Germany.

PMID: 32717978
PMCID: PMC7465768
DOI: 10.3390/jcm9082352

Abstract

Human cytomegalovirus (CMV) remains a major cause of mortality and morbidity in human liver transplant recipients. Anti-CMV therapeutics can be used to prevent or treat CMV in liver transplant recipients, but their toxicity needs to be balanced against the benefits. The choice of prevention strategy (prophylaxis or preemptive treatment) depends on the donor/recipient sero-status but may vary between institutions. We conducted a series of consultations and roundtable discussions with German liver transplant center representatives. Based on 20 out of 22 centers, we herein summarize the current approaches to CMV prevention and treatment in the context of liver transplantation in Germany. In 90% of centers, transient prophylaxis with ganciclovir or valganciclovir was standard of care in high-risk (donor CMV positive, recipient CMV naive) settings, while preemptive therapy (based on CMV viremia detected during (bi) weekly PCR testing for circulating CMV-DNA) was preferred in moderate- and low-risk settings. Duration of prophylaxis or intense surveillance was 3-6 months. In the case of CMV infection, immunosuppression was adapted. In most centers, antiviral treatment was initiated based on PCR results (median threshold value of 1000 copies/mL) with or without symptoms. Therefore, German transplant centers report similar approaches to the prevention and management of CMV infection in liver transplantation.

Keywords: OLT; ganciclovir; mTOR inhibitor; valganciclovir.

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Conflict of interest statement

CE has ongoing research collaboration with Merz Pharmaceuticals and Novartis. He received speaker fees from Novartis, Gilead and Merz Pharmaceuticals. MW received fees for consultancies and as a speaker from AbbVie, Akcea, Amgen, Bayer, BMS, Gilead, Hexal, Novartis, Roche. Travel support was provided by AbbVie, Astellas, Bayer, BMS, Novartis, Janssen, Roche. TZ received Speaker fees and fees for advisory boards from Astellas, Novartis, Roche. GD received Speaker fee, fees for Advisory boards and Travel costs from AbbVie, Falk, Gilead, GMP, Orphan, Intercept, Novartis. FB received speaker fees, fees for advisory boards and travel costs from Novartis, Astellas, Biotest, Chiesi, Roche. All other authors declared no conflict of interest related to this manuscript.

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Prevention and Management of CMV Infections after Liver Transplantation: Current Practice in German Transplant Centers

Affiliations

Prevention and Management of CMV Infections after Liver Transplantation: Current Practice in German Transplant Centers

Authors

Affiliations

Abstract

Conflict of interest statement

References

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous