Cytomegalovirus in Solid Organ Transplantation
Cytomegalovirus in Solid Organ Transplantation
CMV is the most common and single most important viral infection in solid organ transplant recipients. CMV infection usually develops during the first few months after transplantation and is associated with clinical infectious disease (eg, fever, pneumonia, gastrointestinal ulcers, hepatitis) and acute and/or chronic graft injury and dysfunction. In addition to causing febrile illness and organ invasion syndromes (ie, hepatitis and enterocolitis) in solid organ transplant recipients, CMV indirectly influences other clinically and economically relevant outcomes such as reduced patient and graft survival, increased incidence of bacterial and fungal infections, and increased cost and resource utilization. Consequent to the widespread use of antiviral prophylaxis and preemptive therapy, there has been a significant reduction in the incidence and severity of CMV disease and its indirect effects. However, paralleling this improvement is the increasing recognition of infection with ganciclovir-resistant CMV.
It is no surprise, then, that a large number of questions about CMV have been submitted from readers to the Medscape Transplantation Ask the Experts panel during the last couple of years. Selected questions and the expert responses from Marc E. Uknis, MD (Figure 1), Shimon Kusne, MD (Figure 2) and Parmjeet Randhawa, MD (Figure 3) are listed below.
Ask the Experts, one of Medscape Transplantation's most popular features, is accessible via the Medscape Transplantation home page to anyone registered as a physician. Scroll about three quarters of the way down the right side of the page to the blue bar labeled "Discussions." Once there, click on recent questions featured in the box below or click on the "More" button, which will take you to a Directory Page where you will find questions listed and categorized into 8 topics. More than 300 questions have been posted.
If you haven't taken advantage of this service, click on one of the Transplantation Ask the Experts topics, click on "Submit a Question" in the blue box to the right, and send me your questions on CMV or any other clinical management aspect of transplantation.
CMV is the most common and single most important viral infection in solid organ transplant recipients. CMV infection usually develops during the first few months after transplantation and is associated with clinical infectious disease (eg, fever, pneumonia, gastrointestinal ulcers, hepatitis) and acute and/or chronic graft injury and dysfunction. In addition to causing febrile illness and organ invasion syndromes (ie, hepatitis and enterocolitis) in solid organ transplant recipients, CMV indirectly influences other clinically and economically relevant outcomes such as reduced patient and graft survival, increased incidence of bacterial and fungal infections, and increased cost and resource utilization. Consequent to the widespread use of antiviral prophylaxis and preemptive therapy, there has been a significant reduction in the incidence and severity of CMV disease and its indirect effects. However, paralleling this improvement is the increasing recognition of infection with ganciclovir-resistant CMV.
It is no surprise, then, that a large number of questions about CMV have been submitted from readers to the Medscape Transplantation Ask the Experts panel during the last couple of years. Selected questions and the expert responses from Marc E. Uknis, MD (Figure 1), Shimon Kusne, MD (Figure 2) and Parmjeet Randhawa, MD (Figure 3) are listed below.
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Figure 1. Marc E. Uknis, MD, Assistant Professor of Surgery and Microbiology at University of Massachusetts Medical School, Worcester, and a transplant surgeon at Umass Memorial Health Care, Worcester, Massachusetts. |
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Figure 2. Shimon Kusne, MD, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona. |
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Figure 3. Parmjeet Randhawa, MD, Associate Professor of Pathology and Surgery at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. |
Ask the Experts, one of Medscape Transplantation's most popular features, is accessible via the Medscape Transplantation home page to anyone registered as a physician. Scroll about three quarters of the way down the right side of the page to the blue bar labeled "Discussions." Once there, click on recent questions featured in the box below or click on the "More" button, which will take you to a Directory Page where you will find questions listed and categorized into 8 topics. More than 300 questions have been posted.
If you haven't taken advantage of this service, click on one of the Transplantation Ask the Experts topics, click on "Submit a Question" in the blue box to the right, and send me your questions on CMV or any other clinical management aspect of transplantation.
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