Cytomegalovirus (CMV) in Transplant Patients

Overview

What is cytomegalovirus (CMV)?

CMV is short for cytomegalovirus. It is a type of herpes virus. CMV can affect almost any organ and cause almost any type of infection. Anti-rejection drugs taken after surgery help prevent a rejection episode, but they also inhibit part of the immune system. Since the body’s ability to fight infection is decreased, transplant recipients are more prone to viruses and infections.

Symptoms and Causes

What are the symptoms of cytomegalovirus (CMV)?

Since CMV can affect almost any organ, it can cause many different symptoms. However, the majority of CMV infections are without symptoms (asymptomatic). If present, some symptoms include:

  • Fever with temperature greater than 100.4 degrees Fahrenheit or 38 degrees Celsius
  • Low white blood cell counts (leukopenia)
  • Muscle weakness
  • Fatigue
  • Shortness of breath
  • Blurry vision or loss of vision. CMV often infects one eye and tends to infect the other.
  • Abdominal pain, blood in stools, nausea, vomiting or diarrhea. This is due to CMV gastritis or colitis—stomach or colon infection.
  • Seizures, headaches, confusion or coma. This is due to CMV encephalitis, or brain infection.

What causes cytomegalovirus (CMV)?

CMV is most often caused by a reactivation of CMV acquired long before your transplant. If you develop your first CMV infection, the virus likely came from your transplanted organ. (The donor might have been exposed to the virus.) CMV is transmitted by contact between mucous membranes (the mouth and genitals) and live virus present in the secretions of infected CMV patients.

Diagnosis and Tests

How is cytomegalovirus (CMV) diagnosed?

CMV is difficult to diagnose, since its symptoms mimic many other illnesses. CMV might be detected through blood tests that indicate the presence of the CMV virus. Urine and sputum cultures also might detect the virus. Biopsy of the infected organ can also indicate the presence of the CMV virus.

Management and Treatment

How is cytomegalovirus (CMV) treated?

Patients diagnosed with CMV are treated with antiviral medicine delivered intravenously (through your vein) or by mouth.

Prevention

How is cytomegalovirus (CMV) prevented?

CMV infection after transplant can be prevented by monitoring of blood tests and the use of antiviral medications.

Outlook / Prognosis

What is the outlook for transplant patients with cytomegalovirus (CMV) infection?

Recovery might take a long time, and patients are advised to increase activity and exercise gradually, while including periods of rest throughout the recovery. There is no cure for CMV. Once you have been infected with CMV, the virus remains inactive and can cause infection again in the future. However, most patients are able to stop antiviral medications after treatment is completed.

Last reviewed by a Cleveland Clinic medical professional on 07/26/2019.

References

  • Expert knowledge and experience of healthcare providers at Cleveland Clinic.
  • Centers for Disease Control and Prevention. Cytomegalovirus (CMV) and Congenital CMV Infection. (https://www.cdc.gov/cmv/index.html) Accessed 7/30/2019.
  • Azevedo LS, Pierrotti LC, Abdala E, et al. Cytomegalovirus infection in transplant recipients. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4496754/) Clinics (Sao Paulo). 2015;70(7):515–523.
  • Kotton CN, Kumar D, Caliendo AM, et al. The Third International Consensus Guidelines on the Management of Cytomegalovirus in Solid-organ Transplantation. Transplantation. 2018;102(6):900-931.

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