CMV SEMINAR
CMV SEMINAR
Hepatitis B,
Pneumococus ( PCV13, 8 weeks later PPSV23)
Influenza
Hepatitis A, VZV ?
She received methylprednisolone and then tacrolimus, cellcept and
5mg prednisolone for prevention of graft rejection.
Which strategy for CMV prevention do you recommend?
Prophylaxis?
Preemptive?
Preemptive Treatment
CMV Spectrum
Some centers add CMV immunoglobulin (CMV Ig) for heart, lung,
and bowel transplants
R+ Patients:
After 2 weeks the viral load was undetectable and the valcyte was discontinued
but 1 month later the viral load became positive again: at load of 12,000.
Gancyclovir 5mg/Kg BD was started,
1 week later : CMV viral load=12,800, What do you do?
After 2 weeks CMV viral load=100,000, what do you do ?
Definitions of resistance
Failing to respond after at least two weeks of appropriately dosed antiviral treatment should be suspected of
having drug‐resistant virus
Genotypic assays to detect UL97 mutation should be performed among patients suspected to have resistance
to ganciclovir, and UL54 mutation analysis should be performed among patients suspected to have resistance
to ganciclovir, foscarnet, and cidofovir
reduction in immunosuppression
Maybe switch to sirolimus‐containing regimen
Options for empiric treatment :
high‐dose intravenous ganciclovir (up to 10 mg/kg q 12 hours, renally adjusted)
or foscarnet ( unavailable, nephrotoxic)
Cidofovir, Maribavir, Letermovir, IVIG
Leflunamide, Artesunate