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The Third International Consensus Guidelines on the Management of Cytomegalovirus in Solid-organ Transplantation

Kotton, Camille, N., MD1; Kumar, Deepali, MD2; Caliendo, Angela, M., MD, PhD3; Huprikar, Shirish, MD4; Chou, Sunwen, MD5; Danziger-Isakov, Lara, MD, MPH6; Humar, Atul, MD7on behalf of the The Transplantation Society International CMV Consensus Group

doi: 10.1097/TP.0000000000002191
Reviews

Despite recent advances, cytomegalovirus (CMV) infections remain one of the most common complications affecting solid organ transplant recipients, conveying higher risks of complications, graft loss, morbidity, and mortality. Research in the field and development of prior consensus guidelines supported by The Transplantation Society has allowed a more standardized approach to CMV management. An international multidisciplinary panel of experts was convened to expand and revise evidence and expert opinion-based consensus guidelines on CMV management including prevention, treatment, diagnostics, immunology, drug resistance, and pediatric issues. Highlights include advances in molecular and immunologic diagnostics, improved understanding of diagnostic thresholds, optimized methods of prevention, advances in the use of novel antiviral therapies and certain immunosuppressive agents, and more savvy approaches to treatment resistant/refractory disease. The following report summarizes the updated recommendations.

1 Transplant and Immunocompromised Host Infectious Diseases Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

2 Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.

3 Rhode Island Hospital, Providence, RI.

4 Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.

5 Division of Infectious Diseases, Oregon Health & Science University, Portland, OR.

6 Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

7 Multi Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.

Received 15 January 2018. Revision received 12 March 2018.

Accepted 13 March 2018.

C.N.K. received funding for serving on scientific advisory boards for Roche Molecular and Merck; adjudication boards for Astellas, Merck, and Shire; and consultancy fees from Qiagen and Oxford Immunotec. A.M.C. received funding for serving on a scientific advisory board for Roche Molecular. D.K. has received research grants from Roche, Shire, Qiagen, Oxford Immunotec as well as consultancy fees from Qiagen and Oxford Immunotec. S.C. performed contracted CMV phenotyping research for Merck and Shire. S.H. and L.D.-I. have no conflicts to declare. A.H. received research support from Qiagen, Astellas and Roche.

All authors participated in the consensus meeting, review and summary of available data, and in the writing of the article.

The CMV Consensus Conference was organized by the Infectious Diseases Section of The Transplantation Society. Independent, nonrestricted grants from Hoffman LaRoche, Merck, Oxford Immunotec, Qiagen, Shire, CSL Behring, Lophius Biosciences, Chimerix, Roche Molecular Systems, and Abbott Laboratories made this conference possible. At no time did the funding sources have input into the list of attendees, discussion, or content.

Correspondence: Camille N. Kotton, MD, Transplant and Immunocompromised Host Infectious Diseases Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School 55 Fruit Street, Cox 5, Boston, MA 02114. (ckotton@mgh.harvard.edu).

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