Cargando…
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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , |
---|---|
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 |
_version_ | 1783577662750457856 |
---|---|
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. |
format | Online Article Text |
id | pubmed-7465768 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT engelmanncornelius preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT sterneckmartina preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT weisskarlheinz preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT templinsilke preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT zopfsteffen preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT denkgerald preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT eurichdennis preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT pratschkejohann preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT weissjohannes preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT braunfelix preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT welkermartinwalter preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT zimmermanntim preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT knipperpetra preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT nierhoffdirk preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT lorfthomas preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT jackelelmar preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT hauhansmichael preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT tsuitungyu preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT perrakisaristoteles preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT schlitthansjurgen preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT herzerkerstin preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters AT tackefrank preventionandmanagementofcmvinfectionsafterlivertransplantationcurrentpracticeingermantransplantcenters |