Prevention of cytomegalovirus disease in recipients of solid-organ transplants

The introduction and combination of more-potent immunosuppressive regimens, and the increased transplantation of organs into more severely ill patient s, have again placed cytomegalovirus (CMV) disease in the spotlight of post transplantation complications. Both direct and associated complications rel ated to CMV need to be considered in understanding the pathogenesis of CMV infection after solid-organ transplantation. New diagnostic methods with hi gher sensitivity for the detection of CMV and the ability to quantify CMV i ndicate that low levels of CMV replication are present in many patients who don't have clinical symptoms ascribed to CMV infection. How these low leve ls of CMV replication impact the outcome of the transplanted graft remains unknown. In addition, there needs to be further study regarding whether onl y patients at high risk for developing CMV disease or, also, those with cli nically asymptomatic levels of CMV replication should be the target of effe ctive preventive regimens. This review summarizes our current knowledge of the pathogenesis of CMV infection after solid-organ transplantation, and it outlines different effective preventive regimens and approaches.