What are the signs and symptoms of cytomegalovirus (CMV) infection in transplant recipients and how does it affect prognosis?

Updated: Jul 07, 2021
  • Author: Ricardo Cedeno-Mendoza, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

CMV infection in transplant recipients may be primary or recurrent. Again, the former refers to CMV detection in an individual who was previously seronegative, [8] while recurrent infection includes both reinfection and reactivation. Reinfection refers to detection of a CMV strain different from the one that caused the patient's original infection. [8] Reactivation is defined as infection by the same CMV strain as was previously involved. [8]

A study by Kim et al examined CMV infections in patients after liver transplantation. [34] The study determined that the occurrence of CMV disease, and not CMV infection, was a risk factor for mortality and graft failure in adult liver transplant recipients.

CMV infection may cause direct or indirect effects. [35] Direct effects include bone marrow suppression, pneumonia, myocarditis, GI disease, hepatitis, pancreatitis, nephritis, retinitis, and encephalitis, among others. [36, 37] The main indirect effects include acute and chronic graft rejection, accelerated atherosclerosis (heart transplants), secondary bacterial or fungal infections, EBV-associated posttransplant lymphoproliferative disease (PTLD), and decreased graft and patient survival. [35, 36, 37]

CMV infection may affect the same organ systems in HIV-positive patients with low CD4 counts as those in organ transplant recipients. Retinitis has been the major reported CMV disease in patients with HIV infection, followed by CNS involvement.

Not surprisingly, CMV disease has been associated with decreased survival in transplant recipients. As an example, in a group of 187 lung transplant recipients in Sweden between 1990 and 2002, the 10-year survival rate was only 32% in patients with CMV disease, compared with 53% among those with asymptomatic CMV infection and 57% in those without CMV infection. [38]


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