Faculty Opinions recommendation of Effect of preemptive therapy vs antiviral prophylaxis on cytomegalovirus disease in seronegative liver transplant recipients with seropositive donors: A randomized clinical trial.

Abstract

Cytomegalovirus (CMV) is a type of herpes viruses that the transplant community has been dealing with since the inception of solid organ transplantation. CMV is known to infect and may reactivate in liver transplant patients. For a long time we did not have any therapy other than decreasing immunosuppressive medications, which was associated with acute rejection as a complication of the CMV course, and then specific drugs were developed to treat the illness. Currently, valganciclovir is a popular drug for treatment as well as for prophylaxis. Prevention of CMV disease following liver transplantation has remained controversial. Some have used prophylactic protocols with different length, while others have used preemptive therapy. There are studies comparing the two techniques in liver transplant patients. However, until now there hadn't been a randomized trial that investigated and compared the two protocols in high-risk patients. In a multi-center trial, Dr. Sing and colleagues recruited 205 liver transplant patients who were CMV negative and received a liver from a seropositive donor. They documented similar incidence of acute rejection and mortality. But there was significantly less CMV disease in the preemptive group. Details in the paper. The article is a landmark paper that liver transplantation physicians and surgeons should read. Based on this paper, I would favor preemptive therapy.