Infections à cytomégalovirus en transplantation : manifestations cliniques, diagnostic virologique et prise en charge thérapeutique

Cytomegalovirus (CMV) infections remain an important cause of morbidity and mortality among hematopoietic stem cell and solid organ transplant recipients, despite the improvement of infection monitoring using viral DNA quantification by real-time PCR, the optimization of immunosuppressive regimens, and the use of efficient antiviral drugs. Moreover, high immunosuppression and prolonged prophylactic or curative antiviral treatments may lead to the emergence of CMV resistance to antivirals. Antiviral treatment of CMV infections does not undergo a real consensus, although different guidelines exist. The evaluation of risk factors of post-transplantation CMV infection deserves, in addition to routine virological markers, the monitoring of CMV-specific T-cell response. A better understanding of CMV resistance mutations to antivirals and the use of new antiviral drugs are warranted in order to improve therapeutic management of transplant recipients.