espite many recent advances in solid organ transplantation, cytomegalovirus (CMV)infection and disease continue to cause
morbidity and mortality after kidney transplantation. CMV causes cellular damage when viral replication occurs in target
organs including lung, gastrointestinal tract, and liver and can also cause systemic disease. In addition to direct organ damage,
CMV is also associated with aspectrum of less well-categorized indirect effects including increased susceptibility to rejection as
well as to infection with other pathogens.
Risk factors for CMV disease include use of antithymocyte globulin for induction and episodes of rejection. For patients
who are na?ve to the virus, transplant from a CMV-experienceddonor (D+/R-) leads to a higher rate of CMV viremia and disease
compared with other serotype combinations. Methods of immunologic analysis including interferon-gamma enzyme-linked
immunospot assay and tetramer monitoring have been used to define the time course of the anti-CMV immune response that is
crucial for viral control.
Current prevention strategies depend on either preemptive or prophylactic strategies; the most efficacious method and
the period of time that it should be employed are still matters of considerable debate. Treatment is less controversial and relies
primarily on intravenous ganciclovir and oral valganciclovir. Drug resistance is relatively rare but may require change to second
line therapies. New drugs with less toxic side effect profiles are currently in development and may significantly change the field
both in terms of prophylaxis and treatment.
Dr. Joanna M. Schaenman is an Assistant Clinical Professor of Medicine in the Division of Infectious Diseases at the David Geffen School of
Medicine at UCLA. Her specialty is Transplant Infectious Diseases, providing outpatient and inpatient consultation to solid organ transplant recipients
at Ronald Reagan UCLA Medical Center. She has been an invited speaker at the American Society for Microbiology and Infectious Diseases Society
of America meetings, a reviewer for the journal Transplant Infectious Diseases, and a member of the American Society of Transplantation Infectious
Disease Community of Practice. Her research interests center on the antiviral immune response in immunocompromised patients with a focus on
CMV and BK viruses.
Peer Reviewed Journals
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals