Watch a discussion of current unmet needs in the management of CMV post-transplantation

Featured in this video:
• Mr Colin Wilson (Consultant Transplant and Hepatobiliary Surgeon, Newcastle Hospitals)
• Dr Adnan Sharif (Consultant Nephrologist with Special Interest in Transplantation, University Hospitals Birmingham)
• Dr Sowsan Atabani (Consultant Virologist, UK Health Security Agency and University Hospitals Birmingham)

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What is cytomegalovirus (CMV)?

CMV is a common beta virus that is a member of the herpes virus family.1 The prevalence in UK adults is estimated to be 50–60%.²

In immunocompetent individuals, the initial infection is generally asymptomatic but can present as flu-like symptoms.³ After the initial infection, the virus has the ability to establish lifelong latent infection.⁴ In immunocompromised individuals (such as those receiving transplants), new infection, reinfection with a different virus strain, or reactivation of the latent virus can result in serious complications and death.^3,5

Consequently, CMV is one of the most common infections experienced by transplant recipients:

Estimated incidence rate of 16–56% in solid organ transplant (SOT) recipients5	Estimated incidence rate of 30–70% in haematopoietic stem cell transplant (HSCT) recipients6

CMV infection can progress to tissue-invasive disease and may alter the immune system: poor outcomes related to the direct and indirect effects of CMV^7,8

Current challenges in post-transplant CMV

Managing vulnerable transplant patients can be a balancing act. Finding the right level of immunosuppression and treating complications such as emergent CMV infection, while trying to avoid additional treatment burden, adds complexity to post-transplant management.^12,13

CMV considerations post-transplant

Treating refractory CMV infections after transplant can be complicated by safety and tolerability issues. Experts call for new treatment options with specific focus on reducing toxicity without compromising potency.^12,13,17

Identifying the risk factors of refractory CMV could support appropriate management:^19–22

CMV = cytomegalovirus; GvHD = graft-versus-host disease; HLA = human leukocyte antigen.

References:

1. Crought T, Khanna R. Clin Microbiol Rev. 2009;22(1):76–98.
2. NHS Blood and transplant. Factsheet. CMV negative blood components. 2018.
3. Azevedo LS, et al. Clinics (Sao Paulo). 2015;70(7):515–23.
4. Meesing A, Razonable RR. Drugs. 2018;78(11):1085–103.
5. Styczynski J. Infect Dis Ther. 2018;7(1):1–16.
6. Cho SY, et al. Int J Mol Sci. 2019;20(11):2666.
7. Emery VC, et al. Lancet. 2000;355:2032–6.
8. Jorgenson MR, et al. Transpl Infect Dis. 2019;21(3):e13080.
9. Ljungman P, et al. Clin Infect Dis. 2017;64:87–91.
10. Stern M, et al. Transplantation. 2014;98:1013–8.
11. Robin C, et al. BMC Infect Dis. 2017;17:747.
12. Kotton CN, et al. Transplantation. 2018;102:900–31.
13. Ljungman P, et al. Lancet Infect Dis. 2019;19(8):e260–72.
14. Yong MK, et al. BBMT. 2017;23(11):1961–7.
15. Xiao Y, et al. Int J Med Sci. 2014;11(6):652–7.
16. Hakimi Z, et al. Curr Res Transl Med. 2018;66(4):95–101.
17. Khawaja F, et al. Clin Microbiol Infect. 2023;S1198-743X(22)00348–2.
18. Hakimi Z, et al. Transpl Infect Dis. 2017;19(5):doi: 10.1111/tid.12732. Epub 2017 Jul 21.
19. Fisher CE, et al. Clin Infect Dis. 2017;65:57–63.
20. Liu J, et al. Clin Microbiol Infect. 2015;21(12):1121.e9–15.
21. El Chaer F, et al. Blood. 2016;128:2624–36.
22. Sandkovsky U, et al. Transplant Proc. 2018;50(10):3763–8.

Click on the links below to learn more:

An overview of LIVTENCITY▼® (maribavir)

LIVTENCITY safety data

Real-world experiences of using LIVTENCITY

LIVTENCITY efficacy data