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

Despite recent advances, cytomegalovirus 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 cytomegalovirus 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. 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. Terminology: Antigenemia – measuring CMV specific antigen in peripheral blood leukocytes, for example pp65 assay Viremia – culture-based detection of infectious CMV DNAemia – measuring CMV-DNA by QNAT (whole blood and plasma) CMV-specific IgG is a marker of previous exposure (positive serology does not define "active infection") Surveillance – patient at risk, but no evidence of an event or biomarker Monitoring – patient has event or biomarker positive Conflicts of interest Dr. Kotton 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. Dr. Caliendo received funding for serving on a scientific advisory board for Roche Molecular. Dr. Kumar has received research grants from Roche, Shire, Qiagen, Oxford Immunotec as well as consultancy fees from Qiagen and Oxford Immunotec. Dr. Chou performed contracted CMV phenotyping research for Merck and Shire Dr. Huprikar and Dr. Danziger-Isakov have no conflicts to declare. Dr. Humar received research support from Qiagen, Astellas and Roche. Authorship: All authors participated in the consensus meeting, review and summary of available data, and in the writing of the paper. Leaders: Camille N. Kotton (USA) and Atul Humar (Canada) Diagnostics: Angela M. Caliendo (leader, USA), Randall Hayden (USA), Hans Hirsch (Switzerland), Tiziana Lazzarotto (Italy), Jutta Preiksaitis (Canada) Immunology: Deepali Kumar (leader, Canada), Davide Abate (Italy), Oriol Bestard (Spain), Javier Carbone (Spain), Hannah Kaminski (France), Rajiv Khanna (Australia), Martina Sester (Germany) Prevention: Atul Humar (coleader, Canada) and Camille N. Kotton (coleader, USA), Laura Barcan (Argentina), Emily Blumberg (USA), Jennifer Harrison (Canada), Nassim Kamar (France), Nicolas Mueller (Switzerland), Tomas Reischig (Czech Republic), Nina Singh (USA), David Snydman (USA), Helio Tedesco-Silva (Brazil), David Thomson (South Africa), Marty Zamora (USA) Treatment: Shirish Huprikar (leader, USA), Jay Fishman (USA), Shahid Husain (Canada), Michele Morris (USA), Claudia Nagel (Argentina), William Rawlinson (Australia) Resistance: Sunwen Chou (leader, USA), Sophie Alain (France), Guy Boivin (Canada), Klaus Hamprecht (Germany), Ajit P. Limaye (USA) Pediatrics: Lara Danziger-Isakov (leader, USA), Upton Allen (Canada), Michael Green (USA), Britta Hoecker (Germany), Rebecca Madan (USA), Gustavo Varela-Fascinetto (Mexico) Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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