Editorial
Copyright ©2010 Baishideng Publishing Group Co.
World J Hepatol. Sep 27, 2010; 2(9): 325-336
Published online Sep 27, 2010. doi: 10.4254/wjh.v2.i9.325
Table 1 Direct and indirect clinical effects of cytomegalovirus after solid organ transplantation
Direct effectsIndirect effects
CMV syndromeAcute allograft rejection
Fever
Myelosuppression
Malaise
Tissue-invasive CMV disease1Chronic allograft rejection
Gastrointestinal disease (colitis, esophagitis, gastritis, enteritis)Vanishing bile duct syndrome Chronic ductopenic rejection
HepatitisHepatitis C virus recurrence
PneumonitisAllograft hepatitis, fibrosis and allograft failure
CNS disease
Retinitis
MortalityOpportunistic and other infections
Fungal superinfection
Nocardiosis
Bacterial superinfection
Epstein-Barr virus and PTLD
HHV-6 and HHV-7 infections
Vascular thrombosis
Mortality
Table 2 Estimated incidence of cytomegalovirus disease during the first 12 mo after liver transplantation
Use of anti-cytomegalovirus prophylaxis
Yes1 (%)No (%)
CMV D+/R-12-3044-65
CMV D+/R+2.7018.20
CMV D-/R+3.907.90
CMV D-/R-0.000.00
All patients4.8018-29
Table 3 Selected traditional and novel factors associated with increased risk of cytomegalovirus disease after liver transplantation
Traditional factorsRecently identified factors
CMV D+/R- > CMV R+Toll-like receptor gene polymorphism
Allograft rejectionMannose binding lectin deficiency
High viral replicationChemokine and cytokine defects (IL-10, MCP-1, CCR5)
Mycophenolate mofetilDeficiency in CMV-specific CD4+ T cells
Muromonab-CD3Deficiency in CMV-specific CD8+ T cells
Anti-thymocyte globulinExpression of immune evasion genes
AlemtuzumabProgrammed cell death 1 expression
Basiliximab
Human herpesvirus-6
Human herpesvirus-7
Renal insufficiency
Others1
Table 4 Currently available antiviral drugs for cytomegalovirus prophylaxis and treatment in liver transplant recipients
DrugRouteUsual adult prophylaxis doseUsual adult treatment doseComments on use and major toxicity
GanciclovirIntravenous5 mg/kg once daily5 mg/kg twice dailyIntravenous access; leukopenia
GanciclovirOral1 g three times dailyNot applicableLow oral bioavailability; high pill burden
ValganciclovirOral900 mg once daily900 mg twice dailyEase of administration; leukopenia