Ja. Zaia, PREVENTION AND TREATMENT OF CYTOMEGALOVIRUS PNEUMONIA IN TRANSPLANT RECIPIENTS, Clinical infectious diseases, 17, 1993, pp. 190000392-190000399
The prevention of cytomegalovirus (CMV) infection in individuals at th
e highest risk, such as CMV-seronegative recipients of allogeneic bone
marrow transplants or of CMV-positive solid organ transplants, involv
es the use of blood products obtained from CMV-seronegative donors or
the use of filtered blood products. In addition, the use of ganciclovi
r is becoming increasingly important as an early means of preventing s
erious disease. The options for use of ganciclovir include conventiona
l prophylaxis early after engraftment or preemptive use after document
ed infection. Evidence is reviewed for selected use of this drug in on
ly the highest-risk subjects to avoid unnecessary adverse effects. The
optimal use of ganciclovir in specific patient groups needs to be eva
luated, and general recommendations that fit all groups cannot be made
at this time. Although the use of intravenous immunoglobulin (IVIG) i
n transplantation remains controversial, there is increasing evidence
to support a recommendation of the use of IVIG as general support for
the allogeneic bone marrow transplant recipient and of CMV antibody-en
riched immunoglobulin in selected renal transplant recipients. For the
treatment of CMV-associated pneumonitis, it is recommended that ganci
clovir and IVIG be used in combination for the bone marrow transplant
recipient and that ganciclovir be used with or without IVIG in patient
s in other transplantation groups.