Current and Future Strategies for the Prevention and Treatment of Cytomegalovirus Infections in Transplantation

Successful prevention and treatment of cytomegalovirus (CMV) infection remains a central focus of clinical care in solid organ transplantation (SOT) and allogeneic hematopoietic cell transplantation (HCT). Over the past 5 years, pivotal clinical trials have created new paradigms in CMV prevention, including diverging approaches in HCT and SOT. We review recent advances in CMV risk assessment and progress in antiviral and immune-based strategies for CMV prevention and treatment. We highlight approaches to optimize CMV-specific immunity through vaccination, monoclonal antibodies, and virus-specific T cells. Observational studies and interventional trials of commercially available CMV cell-mediated immunity assays for refining preventive and treatment strategies are summarized. Finally, we discuss the importance of enhancing CMV-specific immunity to mitigate the negative impacts of CMV in different transplant settings. CMV infections in recipients of chimeric antigen receptor-T (CAR-T) cell therapies and other immunocompromised populations are growing areas of importance that are beyond the scope of this review.