International consensus guidelines on the management of cytomegalovirus in solid organ transplantation.

Cytomegalovirus (CMV) remains one of the most common infections after solid organ transplantation, resulting in significant morbidity, graft loss, and occasional mortality. Management of CMV varies considerably among transplant centers. A panel of experts on CMV and solid organ transplant was convened by The Infectious Diseases Section of The Transplantation Society to develop evidence and expert opinion-based consensus guidelines on CMV management including diagnostics, immunology, prevention, treatment, drug resistance, and pediatric issues.

[1]  G. Boivin,et al.  Human Cytomegalovirus Resistance to Antiviral Drugs , 2005, Antimicrobial Agents and Chemotherapy.

[2]  H Rollag,et al.  Oral Valganciclovir Is Noninferior to Intravenous Ganciclovir for the Treatment of Cytomegalovirus Disease in Solid Organ Transplant Recipients , 2007, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[3]  T. F. Smith,et al.  Cytomegalovirus (CMV) DNA load predicts relapsing CMV infection after solid organ transplantation. , 2000, The Journal of infectious diseases.

[4]  H. Einsele,et al.  Cidofovir for cytomegalovirus infection and disease in allogeneic stem cell transplant recipients. The Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation. , 2001, Blood.

[5]  T. Pumarola,et al.  The Influence of Innate Immunity Gene Receptors Polymorphisms in Renal Transplant Infections , 2007, Transplantation.

[6]  R. Khanna,et al.  Ex vivo monitoring of human cytomegalovirus‐specific CD8+ T‐cell responses using QuantiFERON®‐CMV , 2007, Transplant infectious disease : an official journal of the Transplantation Society.

[7]  A. Meyerhans,et al.  LEVELS OF VIRUS-SPECIFIC CD4 T CELLS CORRELATE WITH CYTOMEGALOVIRUS CONTROL AND PREDICT VIRUS-INDUCED DISEASE AFTER RENAL TRANSPLANTATION1 , 2001, Transplantation.

[8]  T. Larson,et al.  Allograft rejection predicts the occurrence of late-onset cytomegalovirus (CMV) disease among CMV-mismatched solid organ transplant patients receiving prophylaxis with oral ganciclovir. , 2001, The Journal of infectious diseases.

[9]  Hans-Georg Rammensee,et al.  Infusion of cytomegalovirus (CMV)-specific T cells for the treatment of CMV infection not responding to antiviral chemotherapy. , 2002, Blood.

[10]  F. Cosio,et al.  Delayed-onset primary cytomegalovirus disease and the risk of allograft failure and mortality after kidney transplantation. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[11]  D. Saitovitch,et al.  Antigenemia for cytomegalovirus in renal transplantation: choosing a cutoff for the diagnosis criteria in cytomegalovirus disease. , 2005, Transplantation proceedings.

[12]  C. Payá,et al.  Relationship between Toll-like receptor 2 polymorphism and cytomegalovirus disease after liver transplantation. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[13]  G. Bou,et al.  Impact of current transplantation management on the development of cytomegalovirus disease after renal transplantation. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  W. Freeman,et al.  High-level resistance of cytomegalovirus to ganciclovir is associated with alterations in both the UL97 and DNA polymerase genes. , 1997, The Journal of infectious diseases.

[15]  A. Limaye,et al.  Impact of Cytomegalovirus in Organ Transplant Recipients in the Era of Antiviral Prophylaxis , 2006, Transplantation.

[16]  A. Neumann,et al.  Artesunate as a potent antiviral agent in a patient with late drug-resistant cytomegalovirus infection after hematopoietic stem cell transplantation. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[17]  O. Manuel,et al.  Association between mannose-binding lectin deficiency and cytomegalovirus infection after kidney transplantation. , 2007, Transplantation.

[18]  R. Khanna,et al.  Human cytomegalovirus: clinical aspects, immune regulation, and emerging treatments. , 2004, The Lancet. Infectious diseases.

[19]  R. Vij,et al.  Maribavir prophylaxis for prevention of cytomegalovirus infection in allogeneic stem cell transplant recipients: a multicenter, randomized, double-blind, placebo-controlled, dose-ranging study. , 2008, Blood.

[20]  A. Caliendo,et al.  Clinical utility of quantitative cytomegalovirus viral load determination for predicting cytomegalovirus disease in liver transplant recipients. , 1999, Transplantation.

[21]  R. Ettenger,et al.  Valganciclovir Dosing According to Body Surface Area and Renal Function in Pediatric Solid Organ Transplant Recipients , 2009, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[22]  G. Pantaleo,et al.  Functional Heterogeneity of Memory CD4 T Cell Responses in Different Conditions of Antigen Exposure and Persistence1 , 2005, The Journal of Immunology.

[23]  Maureen F. Maughan,et al.  Development and preclinical evaluation of an alphavirus replicon particle vaccine for cytomegalovirus. , 2007, Vaccine.

[24]  Thomas F. Smith,et al.  The clinical use of various blood compartments for cytomegalovirus (CMV) DNA quantitation in transplant recipients with CMV disease. , 2002, Transplantation.

[25]  S. Chou Cytomegalovirus UL97 mutations in the era of ganciclovir and maribavir , 2008, Reviews in medical virology.

[26]  Rajiv Khanna,et al.  Immunobiology of Human Cytomegalovirus: from Bench to Bedside , 2009, Clinical Microbiology Reviews.

[27]  M. DeBaun,et al.  Cytomegalovirus viremia associated with death or retransplantation in pediatric lung-transplant recipients , 2003, Transplantation.

[28]  V. Kliem,et al.  Improvement in long-term renal graft survival due to CMV prophylaxis with oral ganciclovir: results of a randomized clinical trial. , 2008, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[29]  F. Baldanti,et al.  Clinical and biologic aspects of human cytomegalovirus resistance to antiviral drugs. , 2004, Human immunology.

[30]  Larry R. Smith,et al.  Safety and immunogenicity of a bivalent cytomegalovirus DNA vaccine in healthy adult subjects. , 2008, The Journal of infectious diseases.

[31]  H. Friedman,et al.  Effect of Towne live virus vaccine on cytomegalovirus disease after renal transplant. A controlled trial. , 1991, Annals of internal medicine.

[32]  O. Hes,et al.  Valacyclovir Prophylaxis Versus Preemptive Valganciclovir Therapy to Prevent Cytomegalovirus Disease After Renal Transplantation , 2007, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[33]  S. Chou,et al.  Phenotyping of Cytomegalovirus Drug Resistance Mutations by Using Recombinant Viruses Incorporating a Reporter Gene , 2005, Antimicrobial Agents and Chemotherapy.

[34]  S. Jordan,et al.  Cellular Immune Responses to Cytomegalovirus in Renal Transplant Recipients , 2005, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[35]  F. Baldanti,et al.  Multicenter quality control study for human cytomegalovirus DNAemia quantification. , 2009, The new microbiologica.

[36]  D. Bernstein,et al.  Effect of previous or simultaneous immunization with canarypox expressing cytomegalovirus (CMV) glycoprotein B (gB) on response to subunit gB vaccine plus MF59 in healthy CMV-seronegative adults. , 2002, The Journal of infectious diseases.

[37]  A. Berger,et al.  Human cytomegalovirus infection: diagnostic potential of recombinant antigens for cytomegalovirus antibody detection. , 2001, Journal of virological methods.

[38]  O. Manuel,et al.  Cell‐Mediated Immunity to Predict Cytomegalovirus Disease in High‐Risk Solid Organ Transplant Recipients , 2009, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[39]  J. Spivey,et al.  Safety and efficacy of prolonged cytomegalovirus prophylaxis with intravenous ganciclovir in pediatric and young adult lung transplant recipients , 2007, Pediatric transplantation.

[40]  M. Schnitzler,et al.  Prophylactic Versus Preemptive Oral Valganciclovir for the Management of Cytomegalovirus Infection in Adult Renal Transplant Recipients , 2006, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[41]  H. Rollag,et al.  Cytomegalovirus DNA concentration in plasma predicts development of cytomegalovirus disease in kidney transplant recipients. , 2002, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[42]  S. Arrigain,et al.  The Risk, Prevention, and Outcome of Cytomegalovirus After Pediatric Lung Transplantation , 2009, Transplantation.

[43]  D. Pillay,et al.  THE PROGNOSTIC SIGNIFICANCE OF POSITIVE CMV CULTURES DURING SURVEILLANCE OF RENAL TRANSPLANT RECIPIENTS , 1993, Transplantation.

[44]  G. Boivin,et al.  Analysis of cytomegalovirus DNA polymerase (UL54) mutations in solid organ transplant patients receiving valganciclovir or ganciclovir prophylaxis , 2005, Journal of medical virology.

[45]  H. Einsele,et al.  Ganciclovir-resistant cytomegalovirus disease after allogeneic stem cell transplantation: pitfalls of phenotypic diagnosis by in vitro selection of an UL97 mutant strain. , 2003 .

[46]  E. Benedetti,et al.  Use of high‐dose ganciclovir for a resistant cytomegalovirus infection due to UL97 mutation , 2008, Transplant infectious disease : an official journal of the Transplantation Society.

[47]  A M Caliendo,et al.  Interlaboratory Comparison of Cytomegalovirus Viral Load Assays , 2009, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[48]  N. Smedira,et al.  Significant post‐transplant hypogammaglobulinemia in six heart transplant recipients: an emerging clinical phenomenon? , 2000, Transplant infectious disease : an official journal of the Transplantation Society.

[49]  A. Åsberg,et al.  Long‐Term Outcomes of CMV Disease Treatment with Valganciclovir Versus IV Ganciclovir in Solid Organ Transplant Recipients , 2009, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[50]  J. Preiksaitis,et al.  Canadian Society of Transplantation Consensus Workshop on Cytomegalovirus Management in Solid Organ Transplantation Final Report , 2005, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[51]  F. Baldanti,et al.  Monitoring human cytomegalovirus infection in transplant recipients. , 2008, Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology.

[52]  C. Boucher,et al.  Worldwide Evaluation of DNA Sequencing Approaches for Identification of Drug Resistance Mutations in the Human Immunodeficiency Virus Type 1 Reverse Transcriptase , 1999, Journal of Clinical Microbiology.

[53]  N. Câmara,et al.  The use of sirolimus in ganciclovir‐resistant cytomegalovirus infections in renal transplant recipients , 2007, Clinical transplantation.

[54]  Guy Boivin,et al.  Cytomegalovirus (CMV) virus load kinetics to predict recurrent disease in solid-organ transplant patients with CMV disease. , 2002, The Journal of infectious diseases.

[55]  J. Preiksaitis,et al.  Guidelines for the prevention and management of infectious complications of solid organ transplantation , 2004 .

[56]  A. Limaye Ganciclovir-resistant cytomegalovirus in organ transplant recipients. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[57]  Thomas F. Smith,et al.  Dynamics of cytomegalovirus replication during preemptive therapy with oral ganciclovir. , 2003, The Journal of infectious diseases.

[58]  W. Britt,et al.  A subunit cytomegalovirus vaccine based on recombinant envelope glycoprotein B and a new adjuvant. , 1999, The Journal of infectious diseases.

[59]  S. Chou Cytomegalovirus drug resistance and clinical implications , 2001, Transplant infectious disease : an official journal of the Transplantation Society.

[60]  D. Abramowicz,et al.  The IMPACT Study: Valganciclovir Prophylaxis for until 200 Days Post-Transplant in High Risk Kidney Recipients Substantially Reduces the Incidence of CMV Disease. , 2009 .

[61]  J. Arola,et al.  High frequency of gastroduodenal cytomegalovirus infection in liver transplant patients , 2008, APMIS : acta pathologica, microbiologica, et immunologica Scandinavica.

[62]  F. Baldanti,et al.  Human cytomegalovirus pp67 mRNAemia versus pp65 antigenemia for guiding preemptive therapy in heart and lung transplant recipients: a prospective, randomized, controlled, open-label trial1 , 2003, Transplantation.

[63]  A. Caliendo,et al.  Distinguishing Cytomegalovirus (CMV) Infection and Disease with CMV Nucleic Acid Assays , 2002, Journal of Clinical Microbiology.

[64]  B. Sha Combination Foscarnet and Ganciclovir Therapy vs. Monotherapy for the Treatment of Relapsed Cytomegalovirus Retinitis in Patients with AIDS: The Cytomegalovirus Retreatment Trial , 1996, Archives of ophthalmology.

[65]  S. Chou,et al.  Development of new cytomegalovirus UL97 and DNA polymerase mutations conferring drug resistance after valganciclovir therapy in allogeneic stem cell recipients. , 2007, Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology.

[66]  A. Caliendo,et al.  Comparison of quantitative cytomegalovirus (CMV) PCR in plasma and CMV antigenemia assay: clinical utility of the prototype AMPLICOR CMV MONITOR test in transplant recipients. , 2000, Journal of clinical microbiology.

[67]  H. Piiparinen,et al.  Comparison of two quantitative CMV PCR tests, Cobas Amplicor CMV Monitor and TaqMan assay, and pp65-antigenemia assay in the determination of viral loads from peripheral blood of organ transplant patients. , 2004, Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology.

[68]  Lawrence Corey,et al.  Vaccine prevention of maternal cytomegalovirus infection. , 2009, The New England journal of medicine.

[69]  S. Arrigain,et al.  Correlation between Viral Loads of Cytomegalovirus in Blood and Bronchoalveolar Lavage Specimens from Lung Transplant Recipients Determined by Histology and Immunohistochemistry , 2004, Journal of Clinical Microbiology.

[70]  Boris Katz,et al.  CMV‐IVIG for Prevention of Epstein Barr Virus Disease and Posttransplant Lymphoproliferative Disease in Pediatric Liver Transplant Recipients , 2006, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[71]  S. Chou,et al.  Maribavir sensitivity of cytomegalovirus isolates resistant to ganciclovir, cidofovir or foscarnet. , 2006, Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology.

[72]  I. Binet,et al.  Cytomegalovirus-specific T-cell responses and viral replication in kidney transplant recipients , 2008, Journal of Translational Medicine.

[73]  B. Mayer,et al.  CMV‐hyperimmune globulin for preventing cytomegalovirus infection and disease in solid organ transplant recipients: a meta‐analysis , 2007, Clinical transplantation.

[74]  1999 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus. U.S. Public Health Service (USPHS) and Infectious Diseases Society of America (IDSA). , 2000, Infectious diseases in obstetrics and gynecology.

[75]  A. Humar,et al.  American Society of Transplantation Recommendations for Screening, Monitoring and Reporting of Infectious Complications in Immunosuppression Trials in Recipients of Organ Transplantation , 2006, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[76]  C. Sabin,et al.  Application of viral-load kinetics to identify patients who develop cytomegalovirus disease after transplantation , 2000, The Lancet.

[77]  C. Crumpacker,et al.  Comparison of Quantitative and Qualitative PCR Assays for Cytomegalovirus DNA in Plasma , 2001, Journal of Clinical Microbiology.

[78]  P. Cagle,et al.  THE DIAGNOSIS OF CMV PNEUMONITIS IN LUNG AND HEART/LUNG TRANSPLANT PATIENTS BY PCR COMPARED WITH TRADITIONAL LABORATORY CRITERIA , 1993, Transplantation.

[79]  J. Bremer,et al.  Analysis and characterization of antiviral drug-resistant cytomegalovirus isolates from solid organ transplant recipients. , 2002, The Journal of infectious diseases.

[80]  D. Schoenfeld,et al.  Prevention of primary cytomegalovirus disease in organ transplant recipients with oral ganciclovir or oral acyclovir prophylaxis , 2000, Transplant infectious disease : an official journal of the Transplantation Society.

[81]  Louis J. Picker,et al.  Broadly targeted human cytomegalovirus-specific CD4+ and CD8+ T cells dominate the memory compartments of exposed subjects , 2005, The Journal of experimental medicine.

[82]  C. Crumpacker,et al.  Interstrain Variation in the Human Cytomegalovirus DNA Polymerase Sequence and Its Effect on Genotypic Diagnosis of Antiviral Drug Resistance , 1999, Antimicrobial Agents and Chemotherapy.

[83]  S. Chou,et al.  Viral DNA polymerase mutations associated with drug resistance in human cytomegalovirus. , 2003, The Journal of infectious diseases.

[84]  H. Doerr,et al.  Screening of blood donors for human cytomegalovirus (HCMV) IgG antibody with an enzyme immunoassay using recombinant antigens. , 1999, Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology.

[85]  J. Cisneros,et al.  Preemptive therapy for the prevention of cytomegalovirus disease following heart transplantation directed by PP65 antigenemia. , 2003, Transplantation proceedings.

[86]  A. Limaye,et al.  Programmed death-1 expression in liver transplant recipients as a prognostic indicator of cytomegalovirus disease. , 2008, The Journal of infectious diseases.

[87]  L. Krogerus,et al.  Cytomegalovirus infection of the liver transplant: virological, histological, immunological, and clinical observations , 2006, Transplant infectious disease : an official journal of the Transplantation Society.

[88]  P. Griffiths,et al.  Definitions of cytomegalovirus infection and disease in transplant recipients. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[89]  P. Klenerman,et al.  Functional Impairment of Cytomegalovirus Specific CD8 T Cells Predicts High‐Level Replication After Renal Transplantation , 2008, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[90]  E. Arbustini,et al.  Preemptive Therapy for Systemic and Pulmonary Human Cytomegalovirus Infection in Lung Transplant Recipients , 2009, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[91]  G. Raghu,et al.  High incidence of ganciclovir-resistant cytomegalovirus infection among lung transplant recipients receiving preemptive therapy. , 2002, The Journal of infectious diseases.

[92]  M. DeBaun,et al.  Variability in standard care for cytomegalovirus prevention and detection in pediatric lung transplantation: Survey of eight pediatric lung transplant programs , 2003, Pediatric transplantation.

[93]  T. Lazzarotto,et al.  Validation of an automated immunoglobulin G–only cytomegalovirus (CMV) antibody screening assay and an assessment of the risk of transfusion transmitted CMV from seronegative blood , 2009, Transfusion.

[94]  L. Carruth,et al.  Recovery of Functional Memory T Cells in Lung Transplant Recipients Following Induction Therapy with Alemtuzumab , 2007, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[95]  R. Bevan,et al.  Clinical pharmacokinetics of ganciclovir in patients with normal and impaired renal function. , 1988, Reviews of infectious diseases.

[96]  H. Balfour Options for prevention of cytomegalovirus disease. , 1991, Annals of internal medicine.

[97]  M. Pescovitz Maribavir: a new oral anti-cytomegalovirus drug , 2008 .

[98]  M. Boeckh,et al.  Rising pp65 antigenemia during preemptive anticytomegalovirus therapy after allogeneic hematopoietic stem cell transplantation: risk factors, correlation with DNA load, and outcomes. , 2001, Blood.

[99]  T. Lazzarotto,et al.  Search for cytomegalovirus-specific immunoglobulin M: comparison between a new western blot, conventional western blot, and nine commercially available assays , 1997, Clinical and diagnostic laboratory immunology.

[100]  H. Rollag,et al.  A PROSPECTIVE STUDY OF THE NATURAL COURSE OF CYTOMEGALOVIRUS INFECTION AND DISEASE IN RENAL ALLOGRAFT RECIPIENTS1 , 2000, Transplantation.

[101]  W. Cox,et al.  A canarypox vector-expressing cytomegalovirus (CMV) phosphoprotein 65 induces long-lasting cytotoxic T cell responses in human CMV-seronegative subjects. , 2001, The Journal of infectious diseases.

[102]  H. Rollag,et al.  Impact of early cytomegalovirus infection and disease on long-term recipient and kidney graft survival. , 2004, Kidney international.

[103]  N. Smedira,et al.  HYPOGAMMAGLOBULINEMIA IN LUNG TRANSPLANT RECIPIENTS , 2001, Transplantation.

[104]  M. Ison,et al.  A Survey of CMV Prevention Strategies After Liver Transplantation , 2007, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[105]  R. Avery Update in management of ganciclovir-resistant cytomegalovirus infection , 2008, Current opinion in infectious diseases.

[106]  P. Griffiths,et al.  Use of polymerase chain reaction to provide prognostic information on human cytomegalovirus disease after liver transplantation , 1997, Journal of medical virology.

[107]  L. Cooper,et al.  Induction of Pluripotent Protective Immunity Following Immunisation with a Chimeric Vaccine against Human Cytomegalovirus , 2008, PloS one.

[108]  S. Olofsson,et al.  Quantification of cytomegalovirus DNA in BAL fluid: a longitudinal study in lung transplant recipients. , 2000, Chest.

[109]  B. Alexander,et al.  Efficacy and Safety of Valganciclovir vs. Oral Ganciclovir for Prevention of Cytomegalovirus Disease in Solid Organ Transplant Recipients , 2004, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[110]  H. Balfour,et al.  Ganciclovir susceptibilities and analysis of UL97 region in cytomegalovirus (CMV) isolates from bone marrow recipients with CMV disease after antiviral prophylaxis. , 1998, The Journal of infectious diseases.

[111]  C. Hess,et al.  The Number of Activating KIR Genes Inversely Correlates with the Rate of CMV Infection/Reactivation in Kidney Transplant Recipients , 2008, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[112]  D. Dunn,et al.  Cytomegalovirus disease recurrence after ganciclovir treatment in kidney and kidney-pancreas transplant recipients. , 1999, Transplantation.

[113]  H. Kessler,et al.  Detection of CMV DNA: is EDTA whole blood superior to EDTA plasma? , 2008, Journal of virological methods.

[114]  T. Kotsimbos,et al.  Linking CMV Serostatus to Episodes of CMV Reactivation Following Lung Transplantation by Measuring CMV‐Specific CD8+ T‐Cell Immunity , 2008, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[115]  F. Baldanti,et al.  Evaluation of Cytomegalovirus DNAaemia versus pp65-Antigenaemia Cutoff for Guiding Preemptive therapy in Transplant Recipients: A Randomized Study , 2007, Antiviral therapy.

[116]  H. Schäfers,et al.  Differences in CMV‐Specific T‐Cell Levels and Long‐Term Susceptibility to CMV Infection after Kidney, Heart and Lung Transplantation , 2005, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[117]  A. Weinberg,et al.  Treatment of multidrug‐resistant cytomegalovirus retinitis with systemically administered leflunomide , 2006, Transplant infectious disease : an official journal of the Transplantation Society.

[118]  M. Battiwalla,et al.  Leflunomide failure to control recurrent cytomegalovirus infection in the setting of renal failure after allogeneic stem cell transplantation , 2007, Transplant infectious disease : an official journal of the Transplantation Society.

[119]  J. Preiksaitis,et al.  The risk of transfusion‐acquired CMV infection in seronegative solid‐organ transplant recipients receiving non‐WBC‐reduced blood components not screened for CMV antibody (1984 to 1996): experience at a single Canadian center , 2002, Transfusion.

[120]  P. Gattuso,et al.  Bronchioloalveolar lavage in the diagnosis of CMV pneumonitis in lung transplant recipients: An immunocytochemical study , 1997, Diagnostic cytopathology.

[121]  R. Harvey,et al.  Potent and Selective Inhibition of Human Cytomegalovirus Replication by 1263W94, a Benzimidazole l-Riboside with a Unique Mode of Action , 2002, Antimicrobial Agents and Chemotherapy.

[122]  A. Limaye,et al.  Emergence of ganciclovir-resistant cytomegalovirus disease among recipients of solid-organ transplants , 2000, The Lancet.

[123]  S. Chou,et al.  Growth and Drug Resistance Phenotypes Resulting from Cytomegalovirus DNA Polymerase Region III Mutations Observed in Clinical Specimens , 2007, Antimicrobial Agents and Chemotherapy.

[124]  D. Snydman,et al.  Clinical and epidemiological predictors of recurrent cytomegalovirus disease in orthotopic liver transplant recipients. Boston Center for Liver Transplantation CMVIG Study Group. , 1997, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[125]  H. Einsele,et al.  Discordant detection of human cytomegalovirus DNA from peripheral blood mononuclear cells, granulocytes and plasma: correlation to viremia and HCMV infection. , 1998, Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology.

[126]  B. Gärtner,et al.  PD‐1 Expression and IL‐2 Loss of Cytomegalovirus‐ Specific T Cells Correlates with Viremia and Reversible Functional Anergy , 2008, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[127]  D. Snydman,et al.  Clinical and Epidemiological Predictors of Recurrent Cytomegalovirus Disease in Orthotopic Liver Transplant Recipients , 1997 .

[128]  Guy Boivin,et al.  Resistance of herpesviruses to antiviral drugs: clinical impacts and molecular mechanisms. , 2002, Drug resistance updates : reviews and commentaries in antimicrobial and anticancer chemotherapy.

[129]  D. Faulds,et al.  Ganciclovir. An update of its use in the prevention of cytomegalovirus infection and disease in transplant recipients. , 1998, Drugs.

[130]  G. Snell,et al.  Human cytomegalovirus load in plasma and bronchoalveolar lavage fluid: a longitudinal study of lung transplant recipients. , 2004, The Journal of infectious diseases.

[131]  S. Mulgaonkar,et al.  Establishing pharmacokinetic bioequivalence of valganciclovir oral solution versus the tablet formulation. , 2007, Transplantation proceedings.

[132]  D. Snydman,et al.  Hypogammaglobulinemia in Liver Transplant Recipients: Incidence, Timing, Risk Factors, and Outcomes , 2006, Transplantation.

[133]  J. Bueno,et al.  Current Management Strategies for the Prevention and Treatment of Cytomegalovirus Infection in Pediatric Transplant Recipients , 2002, Paediatric drugs.

[134]  T. Berney,et al.  Natural Killer Cell Receptor Repertoire and Their Ligands, and the Risk of CMV Infection After Kidney Transplantation , 2008, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[135]  A. Limaye,et al.  Incidence and clinical features of ganciclovir-resistant cytomegalovirus disease in heart transplant recipients. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[136]  B. Gärtner,et al.  Monitoring of CMV-specific T-cell levels after organ transplantation / Monitoring CMV-spezifischer T-Zellen nach Organtransplantation , 2008 .

[137]  A. Humar,et al.  A Randomized Trial of Ganciclovir versus Ganciclovir Plus Immune Globulin for Prophylaxis Against Epstein-Barr Virus Related Posttransplant Lymphoproliferative Disorder , 2006, Transplantation.

[138]  E. Mylonakis,et al.  Combination antiviral therapy for ganciclovir-resistant cytomegalovirus infection in solid-organ transplant recipients. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[139]  M. Girndt,et al.  Is the cytomegalovirus serologic status always accurate? A comparative analysis of humoral and cellular immunity1 , 2003, Transplantation.

[140]  P. Griffiths,et al.  Prediction of cytomegalovirus load and resistance patterns after antiviral chemotherapy. , 2000, Proceedings of the National Academy of Sciences of the United States of America.

[141]  C. Crumpacker,et al.  Sequencing of Cytomegalovirus UL97 Gene for Genotypic Antiviral Resistance Testing , 2001, Antimicrobial Agents and Chemotherapy.

[142]  D. Lilleri,et al.  Monitoring of Human Cytomegalovirus‐Specific CD4+ and CD8+ T‐Cell Immunity in Patients Receiving Solid Organ Transplantation , 2006, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.