Post-transplant Cytomegalovirus Infection

Cytomegalovirus (CMV) is one of the most common complications among recipients of solid organ transplants (SOT) and hematopoietic stem cell transplants (HSCT).1,2

Among transplant recipients, CMV infection may lead to CMV end-organ disease, increased morbidity, and higher rates of mortality.1,2

Cytomegalovirus Infection illustration


The seroprevalence of CMV is high in the general population of the United States, but has a greater risk of clinical consequences when the immune system is suppressed, such as during SOT or HSCT.1,3,4

Nearly 40,000 solid organ transplants were performed in the US in 2020.5 Earlier studies estimate that the incidence of CMV disease ranges from 8-32% in heart, kidney, and liver recipients, and is as high as 75% in lung recipients.6 Risk factors for CMV disease in SOT include serological mismatch, intense immunosuppression, and lung transplant.1,6 D+/R- transplants are associated with the highest risk of CMV disease (19.2% to 31.3%) because seronegative recipients lack cellular and humoral immunity to CMV.7,8,9

There were about 22,000 HSCTs performed in the US in 2020.10 Estimates for the incidence of CMV disease range from 5% in autologous transplants to 30% in allogeneic transplant.6 Risk factors for CMV infection in HSCT include serological mismatch, treatment for GvHD, and treatment with anti-thymocyte globulin. Seropositive HSCT recipients have the highest risk of CMV reactivation. D-/R+ transplants are at highest risk for infection (36%) because the lack of CMV-specific memory T cells prolongs immunological anti-CMV reconstitution.6,11


CMV infection in transplant recipients is diagnosed through identification of viral replication, which is monitored post-transplant.6,12,13 The most common method is quantitative nucleic acid testing (QNAT), which is a real-time polymerase chain reaction (RT-PCR) method. QNAT, which can be advantageous for standardization, provides quantification of CMV DNA.


CMV is a herpesvirus with double-stranded DNA.2 CMV can lie dormant in cells and reactivate when the host is immunocompromised.6,14,15

The seroprevalence of CMV is high in the general population, with transmission via saliva, sexual contact, placental transfer, breastfeeding, transfusion, and transplantation.15

Primary infection involves the lytic life cycle (lysis of the host cell), but is commonly asymptomatic in immunocompetent hosts.14,15 CMV then enters a latent phase in which the virus lies dormant within a host cell, avoiding immune surveillance. Latency is normally asymptomatic. Reactivation is when the virus re-enters the lytic life cycle. This can be triggered by immunosuppression, inflammation, infection, and stress, and commonly occurs in immunocompromised hosts, such as transplant recipients.15

Navigating CMV

In the post-transplant setting, the transplant team must deploy a risk-based testing strategy to guide the approach to CMV prophylaxis, modulation of immunosuppressive regimen, and if necessary, treatment of CMV.6

Adding to the challenge of CMV management is the presence of refractory CMV, defined as a suboptimal response to antiviral therapy; and resistant CMV, a laboratory definition of a drug-resistant phenotype or the presence of mutations known to confer resistance to antiviral agents.16 CMV that is refractory and/or resistant to treatment can lead to high morbidity and mortality rates.16,17 Ongoing and future research looks to improve sequencing and detection of mutations, and identification of optimal therapeutic strategies.16

Upcoming & Past Conferences in Transplant Medicine

  • Upcoming

  • Past

American Transplant Congress (ATC), 2024

June 1 - 5, 2024 | Link to Event

A forum for exchange of new scientific and clinical information in solid organ and tissue transplantation, bringing together a wide diversity of transplant professionals.

Tandem Meetings | Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR (TCT), 2024

February 21 - 24, 2024

A comprehensive event including a variety of leading experts in the field of transplantation and cellular therapy discussing the latest developments through scientific sessions, oral abstracts and posters.

American Society of Hematology (ASH), 2023

December 9 - 12, 2023

The premier global congress from the world's largest professional society serving both clinicians and scientists working in malignant and classical hematology.

Academy of Managed Care Pharmacy Nexus (AMCP Nexus), 2023

October 16 - 19, 2023

Annual event with more than 2,500 members and non-members of the AMCP to engage on the latest innovations and most intentional networking in managed care pharmacy.

  • A Multinational Study Assessing Treatment Patterns, Clinical Outcomes, and Healthcare Resource Utilization in Solid Organ Transplant Recipients With Refractory/Resistant Cytomegalovirus Infection or Intolerance to Anti-Cytomegalovirus Therapy

Livtencity® (maribavir)

  • Multinational Study Assessing Treatment Patterns, Outcomes, and Healthcare Resource Utilization in Hematopoietic Stem Cell Transplant Recipients With Refractory/Resistant Cytomegalovirus Infection, or Intolerance to Anti-Cytomegalovirus Therapies

ID Week, 2023

October 11 - 15, 2023

The joint annual meeting of leading global societies dedicated to infectious disease research and advances.

American College of Clinical Pharmacy (ACCP), 2023

September 10 - 12, 2023

Global conference on clinical pharmacy with the goal of advancing clinical pharmacist roles and responsibilities to optimize pharmacotherapy in the prevention and treatment of disease.

Livtencity® (maribavir)

  • Impact of Time From Transplant to Treatment of Patients With Refractory Cytomegalovirus Infection: Post Hoc Analysis of Phase 3 SOLSTICE Study

American Transplant Congress (ATC), 2023

June 3 - 7, 2023

A forum for exchange of new scientific and clinical information in solid organ and tissue transplantation, bringing together a wide diversity of transplant professionals.

International Society for Heart & Lung Transplantation (ISHLT), 2023

April 19 - 22, 2023

One of the largest gatherings of healthcare practitioners, researchers, and allied health professionals focused on advanced treatment for end-stage heart and lung disease.

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