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Prevention and Management of CMV Infections after Liver Transplantation: Current Practice in German Transplant Centers

Human cytomegalovirus (CMV) remains a major cause of mortality and morbidity in human liver transplant recipients. Anti-CMV therapeutics can be used to prevent or treat CMV in liver transplant recipients, but their toxicity needs to be balanced against the benefits. The choice of prevention strategy...

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Autores principales: Engelmann, Cornelius, Sterneck, Martina, Weiss, Karl Heinz, Templin, Silke, Zopf, Steffen, Denk, Gerald, Eurich, Dennis, Pratschke, Johann, Weiss, Johannes, Braun, Felix, Welker, Martin-Walter, Zimmermann, Tim, Knipper, Petra, Nierhoff, Dirk, Lorf, Thomas, Jäckel, Elmar, Hau, Hans-Michael, Tsui, Tung Yu, Perrakis, Aristoteles, Schlitt, Hans-Jürgen, Herzer, Kerstin, Tacke, Frank
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465768/
https://www.ncbi.nlm.nih.gov/pubmed/32717978
http://dx.doi.org/10.3390/jcm9082352
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author Engelmann, Cornelius
Sterneck, Martina
Weiss, Karl Heinz
Templin, Silke
Zopf, Steffen
Denk, Gerald
Eurich, Dennis
Pratschke, Johann
Weiss, Johannes
Braun, Felix
Welker, Martin-Walter
Zimmermann, Tim
Knipper, Petra
Nierhoff, Dirk
Lorf, Thomas
Jäckel, Elmar
Hau, Hans-Michael
Tsui, Tung Yu
Perrakis, Aristoteles
Schlitt, Hans-Jürgen
Herzer, Kerstin
Tacke, Frank
author_facet Engelmann, Cornelius
Sterneck, Martina
Weiss, Karl Heinz
Templin, Silke
Zopf, Steffen
Denk, Gerald
Eurich, Dennis
Pratschke, Johann
Weiss, Johannes
Braun, Felix
Welker, Martin-Walter
Zimmermann, Tim
Knipper, Petra
Nierhoff, Dirk
Lorf, Thomas
Jäckel, Elmar
Hau, Hans-Michael
Tsui, Tung Yu
Perrakis, Aristoteles
Schlitt, Hans-Jürgen
Herzer, Kerstin
Tacke, Frank
author_sort Engelmann, Cornelius
collection PubMed
description Human cytomegalovirus (CMV) remains a major cause of mortality and morbidity in human liver transplant recipients. Anti-CMV therapeutics can be used to prevent or treat CMV in liver transplant recipients, but their toxicity needs to be balanced against the benefits. The choice of prevention strategy (prophylaxis or preemptive treatment) depends on the donor/recipient sero-status but may vary between institutions. We conducted a series of consultations and roundtable discussions with German liver transplant center representatives. Based on 20 out of 22 centers, we herein summarize the current approaches to CMV prevention and treatment in the context of liver transplantation in Germany. In 90% of centers, transient prophylaxis with ganciclovir or valganciclovir was standard of care in high-risk (donor CMV positive, recipient CMV naive) settings, while preemptive therapy (based on CMV viremia detected during (bi) weekly PCR testing for circulating CMV-DNA) was preferred in moderate- and low-risk settings. Duration of prophylaxis or intense surveillance was 3–6 months. In the case of CMV infection, immunosuppression was adapted. In most centers, antiviral treatment was initiated based on PCR results (median threshold value of 1000 copies/mL) with or without symptoms. Therefore, German transplant centers report similar approaches to the prevention and management of CMV infection in liver transplantation.
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spelling pubmed-74657682020-09-04 Prevention and Management of CMV Infections after Liver Transplantation: Current Practice in German Transplant Centers Engelmann, Cornelius Sterneck, Martina Weiss, Karl Heinz Templin, Silke Zopf, Steffen Denk, Gerald Eurich, Dennis Pratschke, Johann Weiss, Johannes Braun, Felix Welker, Martin-Walter Zimmermann, Tim Knipper, Petra Nierhoff, Dirk Lorf, Thomas Jäckel, Elmar Hau, Hans-Michael Tsui, Tung Yu Perrakis, Aristoteles Schlitt, Hans-Jürgen Herzer, Kerstin Tacke, Frank J Clin Med Article Human cytomegalovirus (CMV) remains a major cause of mortality and morbidity in human liver transplant recipients. Anti-CMV therapeutics can be used to prevent or treat CMV in liver transplant recipients, but their toxicity needs to be balanced against the benefits. The choice of prevention strategy (prophylaxis or preemptive treatment) depends on the donor/recipient sero-status but may vary between institutions. We conducted a series of consultations and roundtable discussions with German liver transplant center representatives. Based on 20 out of 22 centers, we herein summarize the current approaches to CMV prevention and treatment in the context of liver transplantation in Germany. In 90% of centers, transient prophylaxis with ganciclovir or valganciclovir was standard of care in high-risk (donor CMV positive, recipient CMV naive) settings, while preemptive therapy (based on CMV viremia detected during (bi) weekly PCR testing for circulating CMV-DNA) was preferred in moderate- and low-risk settings. Duration of prophylaxis or intense surveillance was 3–6 months. In the case of CMV infection, immunosuppression was adapted. In most centers, antiviral treatment was initiated based on PCR results (median threshold value of 1000 copies/mL) with or without symptoms. Therefore, German transplant centers report similar approaches to the prevention and management of CMV infection in liver transplantation. MDPI 2020-07-23 /pmc/articles/PMC7465768/ /pubmed/32717978 http://dx.doi.org/10.3390/jcm9082352 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Engelmann, Cornelius
Sterneck, Martina
Weiss, Karl Heinz
Templin, Silke
Zopf, Steffen
Denk, Gerald
Eurich, Dennis
Pratschke, Johann
Weiss, Johannes
Braun, Felix
Welker, Martin-Walter
Zimmermann, Tim
Knipper, Petra
Nierhoff, Dirk
Lorf, Thomas
Jäckel, Elmar
Hau, Hans-Michael
Tsui, Tung Yu
Perrakis, Aristoteles
Schlitt, Hans-Jürgen
Herzer, Kerstin
Tacke, Frank
Prevention and Management of CMV Infections after Liver Transplantation: Current Practice in German Transplant Centers
title Prevention and Management of CMV Infections after Liver Transplantation: Current Practice in German Transplant Centers
title_full Prevention and Management of CMV Infections after Liver Transplantation: Current Practice in German Transplant Centers
title_fullStr Prevention and Management of CMV Infections after Liver Transplantation: Current Practice in German Transplant Centers
title_full_unstemmed Prevention and Management of CMV Infections after Liver Transplantation: Current Practice in German Transplant Centers
title_short Prevention and Management of CMV Infections after Liver Transplantation: Current Practice in German Transplant Centers
title_sort prevention and management of cmv infections after liver transplantation: current practice in german transplant centers
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465768/
https://www.ncbi.nlm.nih.gov/pubmed/32717978
http://dx.doi.org/10.3390/jcm9082352
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