title: Treatment and prevention of cytomegalovirus infection in heart and lung transplantation: an update.
abstract: BACKGROUND
  Heart and lung transplantation are standard therapeutic strategies to improve survival and quality of life in selected patients with end-stage heart or lung diseases. Cytomegalovirus (CMV) is one the most clinically relevant and frequent post-transplant infectious agents, which may cause direct acute syndromes, and chronic indirect graft-related injury. Despite effective antiviral drugs being available to prevent and treat CMV infection, due to the immunosuppression burden and the specific characteristics of thoracic grafts, CMV infection remains a major clinical problem in heart and lung transplant recipients.
  
  
  METHODS
  We performed an extensive literature search focused on studies specifically including heart or lung transplantation, when available, or kidney transplant recipients when data on thoracic transplants were not available. We discuss the pros and cons supporting the use of currently available drugs and strategies for CMV prevention and treatment, highlighting current unmet needs.
  
  
  CONCLUSIONS
  While (Val)Ganciclovir remains the cornerstone of anti-CMV therapy, prolonged universal prophylaxis may expose a large number of patients to an excess of drug toxicity. Additional drugs with lower toxicity may be available in the context of anti-CMV prophylaxis, and effective CMV-risk stratification, by means of novel immune monitoring assays, which may help to customize the therapeutic approach.
authors.affiliation: a Heart and Lung Transplant Program, Academic Hospital S. Orsola-Malpighi , Bologna University , Bologna , Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Potena
authors.affiliation: b Lung Transplant Center, Cardiovascular Thoracic Department , A.O.U. Città della Salute e della Scienza di Torino , Turin , Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Solidoro
authors.affiliation: b Lung Transplant Center, Cardiovascular Thoracic Department , A.O.U. Città della Salute e della Scienza di Torino , Turin , Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Patrucco
authors.affiliation: a Heart and Lung Transplant Program, Academic Hospital S. Orsola-Malpighi , Bologna University , Bologna , Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Borgese
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D024882:Drug Resistance, Viral; D015774:Ganciclovir / Q000627:therapeutic use; D006084:Graft Rejection / Q000517:prevention & control; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016040:Lung Transplantation / Q000009:adverse effects*
chemical_list: D000914:Antibodies, Viral; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D015774:Ganciclovir
keywords: Cytomegalovirus; ganciclovir; heart transplant; lung transplant; prevention; therapy