CMV Landscape
Cytomegalovirus (CMV) is among the most significant pathogens that can complicate solid organ transplantation (SOT), particularly in high-risk cases having seronegative recipients and seropositive donors. Without antiviral prophylaxis, CMV infection develops in many high-risk SOT recipients and can lead to viremia, disease, and organ damage.1
CMV Carries a Heavy Burden in SOT Patients1,2
Cytomegalovirus (CMV), which belongs to the family of human Herpesviridae (HHV-5), remains one of the most common complications for solid organ transplant (SOT) recipients.3
CMV is considered “the troll of transplantation” because it is highly immune-evasive and adapted to humans, making it a serious risk to immunocompromised patients.4,5
Incidence of CMV Disease Is Higher in CMV D+/R– SOT Patients in Clinical Trials6
In the SOT population, when the organ donor is CMV-seropositive (D+) and the organ recipient is CMV-seronegative (R–), these patients are at high risk of CMV disease due to immunosuppression.1,6-8
Incidence in clinical trials of CMV disease in SOT patients6
| D+/R– | R+ | |||||
|---|---|---|---|---|---|---|
| Type of Transplant | Incidence range among studies (%) |
Weighted average incidence (%) (no. of patients with CMV disease/total no. of patients) |
Follow-up period | Incidence range among studies (%) |
Weighted average incidence (%) (no. of patients with CMV disease/total no. of patients) |
Follow-up period |
Kidney 
|
0-50 | 25 (183/739) | 24 w- 3.4 y* |
2-15 | 7 (42/603) | 3 mo-3 y* |
Liver
|
8-40 | 13 (13/258) | 6-12 mo | 0-4 | 3 (1/39) | 12 mo |
Lung
|
10-33 | 15 (4/26) | 3-3.9 y† | 7-19‡ | 17 (25/150) | 3-3.9 y† |
Heart
|
0-25 | 10 (2/20) | 6 mo | 0-14 | 6 (7/127) | 6-12 mo |
D+, CMV-seropositive donor; R–, CMV-seronegative recipient.
*Median
†Mean
‡Includes CMV disease events/patients.
STUDY DESIGN: This review by Limaye and colleagues summarizes current CMV incidences among SOT and allogeneic hematopoietic cell transplant (HCT) recipients, including clinical trials reported since 2010 in which the incidence of CMV disease was stratified by both D/R serological status and the type of transplant performed. As of 2021, CMV continues to have a significant negative impact on transplant recipients, both as a consequence of direct high-grade viral replication with the associated host response and tissue injury (CMV disease) and through complex biological effects mediated by CMV that negatively impact transplant outcomes through indirect effects.9
CMV is a potential cause of morbidity and mortality in SOT patients.9,10
References: 1. Haidar G, Boeckh M, Singh N. Cytomegalovirus infection in solid organ and hematopoietic cell transplantation: state of the evidence. J Infect Dis. 2020;221(Suppl 1):S23-S31. 2. Kotton CN, Kamar N. New insights on CMV management in solid organ transplant patients: prevention, treatment, and management of resistant/refractory disease. Infect Dis Ther. 2023;12:333-342. 3. Gupta M, Shorman M. Cytomegalovirus. National Institutes of Health, National Library of Medicine, NCBI Bookshelf. 2023: StatPearls Publishing. 4. Stern A, Papanicolaou GA. CMV prevention and treatment in transplantation: what’s new in 2019. Curr Infect Dis Rep. 2019;21(11):45. doi:10.1007/s11908-019-0699-0 5. Patro ARK. Subversion of immune response by human cytomegalovirus. Front Immunol. 2019;10:1155 6. Limaye AP, Babu TM, Boeckh M. Progress and challenges in the prevention, diagnosis, and management of cytomegalovirus infection in transplantation. Clin Microbiol Rev. 2020;34(1):e00043-19. 7. Azevedo LS, Pierrotti LC, Abdala E, et al. Cytomegalovirus infection in transplant recipients. Clinics. 2015;70(7):515-523. 8. Kotton CN, Kumar D, Caliendo AM. The Third International Consensus Guidelines on the Management of Cytomegalovirus in Solid-organ Transplantation. Transplantation. 2018;102(6):900-931. 9. Yetmar ZA, Kudva YC, Seville MT, et al. Risk of cytomegalovirus infection and subsequent allograft failure after pancreas transplantation. Am J Transplant. 2024;24(2):271-279. 10. Selvey LA, Lim WH, Boan P, et al. Cytomegalovirus viremia and mortality in renal transplant recipients in the era of antiviral prophylaxis. Lessons from the western Australian experience. BMC Infect Dis. 2017;17(1):501.