Diagnosis and monitoring of human cytomegalovirus infection in transplant recipients

In the last decade, transplantology has become the treatment of choice for a large number of malignant diseases or organ dysfunctions. Transplants are classified into two main groups: solid organ transplants (SOT) and haemato poietic stem cell transplants (HSCT). Human cytomegalovirus (HCMV) infectio n is the most common viral complication in both SOT and HSCT recipients wit hin 3 months of transplant. Major risk factors for HCMV infection are the m ismatch between donor and recipient antibody status, and the immunosuppress ive regimen. Clinical manifestations range from asymptomatic infections to severe HCMV disease involving lung, gastrointestinal tract, liver, retina, central and peripheral nervous systems. Diagnosis is based mainly upon dete ction and quantification of virus in blood by determination of viraemia, an tigenaemia, DNAaemia, and RNAaemia. In addition, detection of the emergence of resistance to HCMV-specific antiviral drugs such as ganciclovir and fos carnet, may be achieved by performing phenotypic and genotypic assays. Moni toring of HCMV infections in both SOT and HSCT recipients allows timely ado ption of pre-emptive (presymptomatic) therapy strategies, which have led to almost complete disappearance of HCMV disease in both transplantation sett ings. In parallel, sustained treatment with specific antiviral drugs must e licit monitoring of antiviral drug resistance to permit a timely shift to a n alternative drug. In conclusion, diagnostic and therapeutic tools now ava ilable allow almost complete control of HCMV infections in different transp lantation settings. (C) 2001 Lippincott Williams & Wilkins.