Skip to main content

Prevention and Treatment of CMV Infection (and Other Herpes Viruses)

  • Chapter
  • First Online:
  • 652 Accesses

Abstract

Cytomegalovirus (CMV) infection is one of the most common viral infections in solid organ transplant (SOT) recipients. In these patients, CMV is an important cause of morbidity due to the development of invasive disease or due to the immunomodulatory effect of the virus on the host immune system. Other herpes viruses (herpes simplex virus 1 and 2, varicella-zoster virus, Epstein-Barr virus, human herpesvirus 6, 7, and 8) are also an important cause of infection in this setting. Over the last few years, new data and consensus documents on the management of these infections have been created. In this chapter, we provide practical recommendations to guide clinicians on the prevention and treatment of infection due to herpes viruses.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Suggested Reading

  • Asberg A, Humar A, Rollag H, Jardine AG, Mouas H, Pescovitz MD, Sgarabotto D, Tuncer M, Noronha IL, Hartmann A. Oral valganciclovir is noninferior to intravenous ganciclovir for the treatment of cytomegalovirus disease in solid organ transplant recipients. Am J Transplant. 2007;7:2106–13.

    Article  CAS  Google Scholar 

  • Asberg A, Humar A, Jardine AG, Rollag H, Pescovitz MD, Mouas H, Bignamini A, Toz H, Dittmer I, Montejo M, Hartmann A, V.S. Group. Long-term outcomes of CMV disease treatment with valganciclovir versus IV ganciclovir in solid organ transplant recipients. Am J Transplant. 2009;9:1205–13.

    Article  CAS  Google Scholar 

  • Asberg A, Jardine AG, Bignamini AA, Rollag H, Pescovitz MD, Gahlemann CC, Humar A, Hartmann A, V.S. Group. Effects of the intensity of immunosuppressive therapy on outcome of treatment for CMV disease in organ transplant recipients. Am J Transplant. 2010;10:1881–8.

    Article  CAS  Google Scholar 

  • Cantisan S, Torre-Cisneros J, Lara R, Rodriguez-Benot A, Santos F, Gutierrez-Aroca J, Gayoso I, Gonzalez-Padilla M, Casal M, Rivero A, Solana R. Age-dependent association between low frequency of CD27/CD28 expression on pp65 CD8+ T cells and cytomegalovirus replication after transplantation. Clin Vaccine Immunol. 2009;16:1429–38.

    Article  CAS  Google Scholar 

  • Cantisan S, Lara R, Montejo M, Redel J, Rodriguez-Benot A, Gutierrez-Aroca J, Gonzalez-Padilla M, Bueno L, Rivero A, Solana R, Torre-Cisneros J. Pretransplant interferon-gamma secretion by CMV-specific CD8+ T cells informs the risk of CMV replication after transplantation. Am J Transplant. 2013;13:738–45.

    Article  CAS  Google Scholar 

  • Cantisán S, Torre-Cisneros J, Lara R, Zarraga S, Montejo M, Solana R. Impact of citomegalovirus on early immunosenescence of CD8+T lymphocytes alter solid organ transplantation. J Gerontol Biol. 2013;68:1–5.

    Article  Google Scholar 

  • Cantisán S, Rodelo-Haad C, Páez-Vega A, Nieto A, Vaquero JM, Poyato A, Montejo M, Fariñas C, Rivero A, Solana R, Martín-Malo A, Torre-Cisneros J. Factors related to the development of CMV-specific CD8fl T cell response in CMV-seropositive solid organ transplant candidates. Am J Transplant. 2015;15:715–22.

    Article  Google Scholar 

  • Cantisán S, Páez-Vega A, Santos F, Rodríguez-Benot A, Aguado R, Rivero A, Montejo M, Torre-Cisneros J, Solana R, Spanish Network for Research in Infectious Diseases (REIPI). Impact of age and cytomegalovirus on CD8+ T-cell compartment remodeling after solid organ transplantation: a one-year follow-up study. Exp Gerontol. 2017;95:98–106. https://doi.org/10.1016/j.exger.2017.04.011.

    Article  CAS  PubMed  Google Scholar 

  • Castón JJ, Castells L, Varo E, Gómez MA, de la Mata M, Campos-Varela I, Lumbreras C, González-Dieguez L, Fabregat J, Herrero I, Salcedo M, Sánchez-Antolín G, de la Torre-Cisneros J. Impact of cytomegalovirus infection on severe hepatitis C recurrence in patients undergoing liver transplantation. Transplantation. 2016;100(3):593–9.

    Article  Google Scholar 

  • Chou S. Approach to drug-resistant cytomegalovirus in transplant recipients. Curr Opin Infect Dis. 2015;28:293–9.

    Article  CAS  Google Scholar 

  • Gracia-Ahufinger I, Gutierrez-Aroca J, Cordero E, Vidal E, Cantisan S, del Castillo D, Martin-Gandul C, Rivero A, Torre-Cisneros J. Use of high-dose ganciclovir for the treatment of cytomegalovirus replication in solid organ transplant patients with ganciclovir resistance-inducing mutations. Transplantation. 2013;95:1015–20.

    Article  CAS  Google Scholar 

  • Humar A, Snydman D. Cytomegalovirus in solid organ transplant recipients. Am J Transplant. 2009;9(Suppl 4):S78–86.

    Article  Google Scholar 

  • Humar A, Gregson D, Caliendo AM, McGeer A, Malkan G, Krajden M, Corey P, Greig P, Walmsley S, Levy G, Mazzulli T. Clinical utility of quantitative cytomegalovirus viral load determination for predicting cytomegalovirus disease in liver transplant recipients. Transplantation. 1999;68:1305–11.

    Article  CAS  Google Scholar 

  • Humar A, Kumar D, Boivin G, Caliendo AM. Cytomegalovirus (CMV) virus load kinetics to predict recurrent disease in solid-organ transplant patients with CMV disease. J Infect Dis. 2002;186:829–33.

    Article  Google Scholar 

  • Humar A, Lebranchu Y, Vincenti F, Blumberg E, Punch JD, Limaye AP, Abramowicz D, Jardine AG, Voulgari AT, Ives J, Hauser IA, Peeters P. The efficacy and safety of 200 days valganciclovir cytomegalovirus prophylaxis in high-risk kidney transplant recipients. Am J Transplant. 2010a;10:1228–37.

    Article  CAS  Google Scholar 

  • Humar A, Limaye AP, Blumberg EA, Hauser IA, Vincenti F, Jardine AG, Abramowicz D, Ives JA, Farhan M, Peeters P. Extended valganciclovir prophylaxis in D+/R- kidney transplant recipients is associated with long-term reduction in cytomegalovirus disease: two-year results of the IMPACT study. Transplantation. 2010b;90:1427–31.

    Article  CAS  Google Scholar 

  • Kotton CN, Kumar D, Caliendo AM, Huprikar S, Chou S, Danziger-Isakov L, Humar A, The Transplantation Society International CMV Consensus Group. The third international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation. 2018;102:900–31.

    Article  Google Scholar 

  • Le J, Gantt S. Human herpesvirus 6, 7 and 8 in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):S128–37.

    Article  Google Scholar 

  • Len O, Gavalda J, Aguado JM, Borrell N, Cervera C, Cisneros JM, Cuervas-Mons V, Gurgui M, Martin-Davila P, Montejo M, Muñoz P, Bou G, Carratala J, Torre-Cisneros J, Pahissa A. Valganciclovir as treatment for cytomegalovirus disease in solid organ transplant recipients. Clin Infect Dis. 2008;46:20–7.

    Article  CAS  Google Scholar 

  • Manuel O. Clinical experience with immune monitoring for cytomegalovirus in solid-organ transplant recipients. Curr Infect Dis Rep. 2013;15:491–6.

    Article  Google Scholar 

  • Manuel O, Husain S, Kumar D, Zayas C, Mawhorter S, Levi ME, Kalpoe J, Lisboa L, Ely L, Kaul DR, Schwartz BS, Morris MI, Ison MG, Yen-Lieberman B, Sebastian A, Assi M, Humar A. Assessment of cytomegalovirus-specific cell-mediated immunity for the prediction of cytomegalovirus disease in high-risk solid-organ transplant recipients: a multicenter cohort study. Clin Infect Dis. 2013;56:817–24.

    Article  CAS  Google Scholar 

  • Martin-Gandul C, Stampf S, Héquet D, Mueller NJ, Cusini A, van Delden C, Khanna N, Boggian K, Hirzel C, Soccal P, Hirsch HH, Pascual M, Meylan P, Manuel O, Swiss Transplant Cohort Study (STCS). Preventive strategies against cytomegalovirus and incidence of α-Herpesvirus infections in solid organ transplant recipients: a nationwide cohort study. Am J Transplant. 2017;17(7):1813–22.

    Article  CAS  Google Scholar 

  • Paya C, Humar A, Dominguez E, Washburn K, Blumberg E, Alexander B, Freeman R, Heaton N, Pescovitz MD. Efficacy and safety of valganciclovir vs. oral ganciclovir for prevention of cytomegalovirus disease in solid organ transplant recipients. Am J Transplant. 2004;4:611–20.

    Article  CAS  Google Scholar 

  • Pergam SA, Limaye AP. Varicella zoster virus infection in solid organ trnsplantation. Am J Transplant. 2013;13(Suppl 4):S138–46.

    Article  Google Scholar 

  • Potena L, Grigioni F, Magnani G, Lazzarotto T, Musuraca AC, Ortolani P, Coccolo F, Fallani F, Russo A, Branzi A. Prophylaxis versus preemptive anti-cytomegalovirus approach for prevention of allograft vasculopathy in heart transplant recipients. J Heart Lung Transplant. 2009;28:461–7.

    Article  Google Scholar 

  • Razonable RR, Humar A. Cytomegalovirus in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):S93–106.

    Article  Google Scholar 

  • Sagedal S, Hartmann A, Nordal KP, Osnes K, Leivestad T, Foss A, Degre M, Fauchald P, Rollag H. Impact of early cytomegalovirus infection and disease on long-term recipient and kidney graft survival. Kidney Int. 2004;66:329–37.

    Article  Google Scholar 

  • Torre-Cisneros J, Aguado JM, Castón JJ, Almenar L, Alonso A, Cantisán S, Carratalá J, Cervera C, Cordero E, Fariñas MC, Fernández-Ruiz M, Fortún J, Frauca E, Gavaldá J, Hernández D, Herrero I, Len O, López-Medrano F, Manito N, Marcos MA, Martín-Dávila P, Monforte V, Montejo M, Moreno A, Muñoz P, Navarro D, Pérez-Romero P, Rodriguez-Bernot A, Rumbao J, San Juan R, Vaquero JM, Vidal E, Spanish Society of Transplantation (SET); Group for Study of Infection in Transplantation of the Spanish Society of Infectious Diseases and Clinical Microbiology (GESITRA-SEIMC); Spanish Network for Research in Infectious Diseases (REIPI). Management of cytomegalovirus infection in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations. Transplant Rev. 2016;30:119–43.

    Article  CAS  Google Scholar 

  • Wilck MB, Zuckerman RA. Herpes simplex virus in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):S121–7.

    Article  Google Scholar 

Download references

Acknowledgments

This is supported by Plan Nacional de I+D+i 2013–2016, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y Competitividad, and Spanish Network for Research in Infectious Diseases (RD16/0016/0008) and co-financed by the European Development Regional Fund “A way to achieve Europe,” Operative Program Intelligent Growth 2014–2020.

Conflict of Interest

JTC has received unrestricted grants and has served as scientific advisor and speaker of Roche Pharma, MSD, Astellas, and Qiagen. AH has received grant support and/or speaker honoraria from Roche, Astellas, Merck, and Qiagen.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Julian Torre-Cisneros .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Torre-Cisneros, J., Humar, A. (2019). Prevention and Treatment of CMV Infection (and Other Herpes Viruses). In: Manuel, O., Ison, M. (eds) Infectious Diseases in Solid-Organ Transplant Recipients. Springer, Cham. https://doi.org/10.1007/978-3-030-15394-6_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-15394-6_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-15393-9

  • Online ISBN: 978-3-030-15394-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics