CMV disease in renal transplantation

Cytomegalovirus (CMV) is the most important viral pathogen in renal transplant recipient and is associated with considerable morbidity and mortality. Following transplant CMV may lead to a broad spectrum of disease including encephalitis, retinitis, hepatitis, Pneumonitis, gastrointestinal ulcers and graft dysfunction. The risk of developing CMV disease depends on various factors including Serological status of donor and recipient, degree of immunosuppression, episodes of acute rejection and degree of graft function. For diagnosis of CMV disease pp65 antigen assay or molecular assay for nucleic acid test is used. For prevention of CMV disease in renal transplant recipients either antiviral prophylaxis or preemptive therapy is used. Both strategies having own sets of advantages and disadvantages. For treatment of established disease either intravenous ganciclovir or oral valganciclovir is used. In resistant cases foscarnet of cidofovir may be used.