Female doctor talking to elderly female patient

Post-transplant Cytomegalovirus Infection

Cytomegalovirus (CMV) is one of the most common complications among recipients of solid organ transplants (SOT) and hematopoietic stem cell transplants (HSCT).1,2

Among transplant recipients, CMV infection may lead to CMV end-organ disease, increased morbidity, and higher rates of mortality.1,2

Viral infection educational diagram

Epidemiology

The seroprevalence of CMV is high in the general population of the United States, but has a greater risk of clinical consequences when the immune system is suppressed, such as during SOT or HSCT.1,3,4

Over 48,000 solid organ transplants were performed in the US in 2024.5 Earlier studies estimate that the incidence of CMV disease ranges from 8-32% in heart, kidney, and liver recipients, and is as high as 75% in lung recipients.6 Risk factors for CMV disease in SOT include serological mismatch, intense immunosuppression, and lung transplant.1,6 D+/R- transplants are associated with the highest risk of CMV disease (19.2% to 31.3%) because seronegative recipients lack cellular and humoral immunity to CMV.7,8,9

There were about 23,000 HSCTs performed in the US in 2023.10 Estimates for the incidence of CMV disease range from 5% in autologous transplants to 30% in allogeneic transplant.6 Risk factors for CMV infection in HSCT include serological mismatch, treatment for GvHD, and treatment with anti-thymocyte globulin. Seropositive HSCT recipients have the highest risk of CMV reactivation. D-/R+ transplants are at highest risk for infection (36%) because the lack of CMV-specific memory T cells prolongs immunological anti-CMV reconstitution.6,11

Pathophysiology

CMV is a herpesvirus with double-stranded DNA.2 CMV can lie dormant in cells and reactivate when the host is immunocompromised.6,14,15

The seroprevalence of CMV is high in the general population, with transmission via saliva, sexual contact, placental transfer, breastfeeding, transfusion, and transplantation.15

Primary infection involves the lytic life cycle (lysis of the host cell), but is commonly asymptomatic in immunocompetent hosts.14,15 CMV then enters a latent phase in which the virus lies dormant within a host cell, avoiding immune surveillance. Latency is normally asymptomatic. Reactivation is when the virus re-enters the lytic life cycle. This can be triggered by immunosuppression, inflammation, infection, and stress, and commonly occurs in immunocompromised hosts, such as transplant recipients.15

Diagnosis

CMV infection in transplant recipients is diagnosed through identification of viral replication, which is monitored post-transplant.6,12,13 The most common method is quantitative nucleic acid testing (QNAT), which is a real-time polymerase chain reaction (RT-PCR) method. QNAT, which can be advantageous for standardization, provides quantification of CMV DNA.

Navigating CMV

In the post-transplant setting, the transplant team must deploy a risk-based testing strategy to guide the approach to CMV prophylaxis, modulation of immunosuppressive regimen, and if necessary, treatment of CMV.6

Adding to the challenge of CMV management is the presence of refractory CMV, defined as a suboptimal response to antiviral therapy; and resistant CMV, a laboratory definition of a drug-resistant phenotype or the presence of mutations known to confer resistance to antiviral agents.16 CMV that is refractory and/or resistant to treatment can lead to high morbidity and mortality rates.16,17 Ongoing and future research looks to improve sequencing and detection of mutations, and identification of optimal therapeutic strategies.16

Scientific Congresses and Resources

This is not intended to be a comprehensive resource of all congresses and congress materials across therapeutic and disease areas. Congress materials may include information about investigational use(s) of compounds/products that are not approved for use by the U.S. Food and Drug Administration (FDA) and/or are inconsistent with the Prescribing Information. Takeda does not recommend the use of any Takeda product beyond the approved labeling. Any decisions regarding the usage of a Takeda product beyond the approved labeling are left to the discretion of the healthcare professional. Takeda makes no representations about whether investigational compounds or unapproved uses will be approved by the FDA.

Transplant & Cellular Therapy Meetings of ASTCT and CIBMTR (TANDEM), 2026

February 4 - 7, 2026 | Link to Event

The Tandem Meetings I Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR are the combined annual meetings of the American Society for Transplantation and Cellular Therapy (ASTCT) and CIBMTR (Center for International Blood and Marrow Transplant Research).

The International Society of Heart and Lung Transplant (ISHLT), 2026

April 22 - 25, 2026 | Link to Event

The ISHLT Annual Meeting & Scientific Sessions is the place to share your work internationally among the world’s most influential professionals in the field of advanced heart and lung failure, transplantation, mechanical circulatory support, and pulmonary vascular disease.

ID Week (ID Week), 2025

October 19 - 22, 2025

The joint annual meeting of leading global societies dedicated to infectious disease research and advances.

World Transplant Congress (WTC), 2025

August 2 - 6, 2025

This global congress draws experts, healthcare practitioners, and researchers providing them with an opportunity to explore in-depth the sector’s newest developments.

European Society for Organ Transplantation (ESOT), 2025

June 29 - July 2, 2025

The ESOT Congress is the leading forum for inspiration in transplantation. Offering endless possibilities on a global scale, the meeting is a platform for growth and collaboration like no other.

Livtencity® (maribavir)

  • Healthcare Provider Preferences for Treatment of Post-Transplant Cytomegalovirus Infection

International Society for Heart and Lung Transplantation (ISHLT), 2025

April 27 - 30, 2025

The ISHLT Annual Meeting is your gateway to the latest science and practice for the care team in advanced heart and lung disease.

Tandem Meetings | Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR (TCT), 2025

February 12 - 15, 2025

A comprehensive event including a variety of leading experts in the field of transplantation and cellular therapy discussing the latest developments through scientific sessions, oral abstracts and posters.

Livtencity® (maribavir)

  • Eliciting Healthcare Provider Preferences for Treatment of Post-Transplant Cytomegalovirus Infection

Medications

This resource provides information on Takeda medications available in the Post-transplant Cytomegalovirus Infection category and is not intended to represent a complete list of therapeutic options.

Livtencity®

(maribavir)

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