From the Research
For patients with detected Cytomegalovirus (CMV) DNA prior to liver transplant, the recommended antiviral prophylaxis is preemptive therapy with valganciclovir at a dose of 900 mg twice daily until 2 consecutive negative tests a week apart, as it has been shown to result in a lower incidence of CMV disease compared to antiviral prophylaxis 1. This approach is based on the results of a randomized clinical trial that compared preemptive therapy with antiviral prophylaxis in CMV-seronegative liver transplant recipients with seropositive donors, which found that preemptive therapy resulted in a significantly lower incidence of CMV disease over 12 months 1. The use of preemptive therapy allows for the early detection and treatment of CMV viremia, reducing the risk of CMV disease and its associated complications. Some studies have suggested that antiviral prophylaxis with valganciclovir may be effective in preventing CMV disease in high-risk patients 2, 3, but the most recent and highest quality study supports the use of preemptive therapy 1. It is essential to note that the management of CMV infection in liver transplant patients requires a comprehensive approach, including regular monitoring of CMV viral load and adjustment of antiviral therapy as needed. Key points to consider in the management of CMV infection in liver transplant patients include:
- The use of preemptive therapy with valganciclovir for patients with detected CMV DNA prior to liver transplant
- Regular monitoring of CMV viral load to guide antiviral therapy
- Adjustment of antiviral therapy based on CMV viral load and clinical symptoms
- Consideration of the recipient's and donor's CMV serostatus in determining the duration of antiviral prophylaxis
- Dose adjustments for patients with renal impairment, with creatinine clearance guiding dosing modifications.