Management of late, recurrent, and resistant cytomegalovirus in transplant patients

The timing and incidence of post-transplant cytomegalovirus (CMV) infections have changed in the era of prophylaxis and preemptive therapy. Late, recurrent, and ganciclovir-resistant CMV syndromes continue to be challenges to clinical management. Recent articles relating to solid-organ transplantation on the topic of CMV occurring after prophylaxis, CMV recurrence, CMV-specific immune reconstitution, and antiviral-resistant CMV were reviewed with particular attention to issues of risk factors, underlying mechanisms, prevention, and management. Recent results from basic research on the cellular immunology and biology of CMV have illuminated clinically observed phenomena related to complex CMV syndromes. Serial measurement of CMV viral load provides valuable information and opportunity for intervention. Although much remains to be learned, current knowledge provides the basis for rational design of CMV prevention and management strategies.