Clinical utility of molecular surveillance for cytomegalovirus after antiviral prophylaxis in high-risk solid organ transplant recipients.
Late CMV disease is common after the discontinuation of prophylaxis especially in the high-risk CMV D+/R- group. Transplant centers take various approaches to detect CMV disease and these include prolonging prophylaxis, doing weekly CMV viral load monitoring, or observing for symptoms. In this single-center review, 71 high-risk patients received 3 months of antiviral prophylaxis followed by 8 weeks of weekly viral load monitoring. Viremia occurred in 19 (27%) of patients during the monitoring period. Monitoring was able to prevent disease in only three cases. This was because many patients had low-level viremia that spontaneously cleared or they already were symptomatic at the time of detection. Some patients had rapid viral load doubling. Alternatives are needed to prevent late CMV disease in the high-risk population.