Benefits of CMV Prophylaxis in Solid Organ Transplantation

Cytomegalovirus infection continues to be one of the leading causes of morbidity in transplant patients. Cytomegalovirus disease causes both direct and indirect effects, with special consideration being given to the latter in recent years. The indirect effects of cytomegalovirus disease include the viral syndrome and the symptoms resulting from direct invasion of the tissues by the virus. The indirect effects are due to the immunomodulation caused by the virus, resulting in an increased incidence of acute rejection, cardiovascular disease, and opportunistic infections. The two main strategies for preventing cytomegalovirus disease are universal prophylaxis and preemptive therapy, with ganciclovir and valganciclovir being the drugs that have shown the most efficacy. Numerous studies have been conducted to evaluate the efficacy of these two strategies. Prophylaxis appears to have shown greater efficacy than preemptive therapy for preventing the indirect effects of cytomegalovirus disease, while both strategies appear to be similar in terms of preventing direct effects. In recent years, late cytomegalovirus disease and the occurrence of ganciclovir-resistant cytomegalovirus strains have taken on special interest. Many issues are still unresolved, such as the most appropriate duration of prophylaxis or which strategy is most appropriate depending on the patient’s risk of acquiring the disease. (Trends in Trans-