Cytomegalovirus Management in Solid Organ Transplant Recipients

Cytomegalovirus (CMV) remains a significant cause of morbidity and mortality in solid organ transplant (SOT) recipients. Despite advancements in prophylaxis and antiviral therapy, CMV continues to pose clinical challenges in transplant medicine. This review provides a comprehensive overview of CMV, exploring its pathophysiology, epidemiology, and clinical presentation in SOT patients, in whom CMV infection can lead to direct organ involvement and systemic symptoms. Additionally, CMV has indirect effects, including graft dysfunction and an increased risk of opportunistic infections. We examine the immune responses to CMV, focusing on the roles of both innate and adaptive immunity. The importance of personalized prophylaxis and preemptive therapy is emphasized based on serostatus and individual risk factors. Furthermore, this review discusses resistance mechanisms to standard therapies exploring alternative treatments.