Management of Cytomegalovirus Infection in Allogeneic Hematopoietic Stem Cell and in Solid Organ Transplantation: Updated Recommendations by the GITMO, SITO, SIMIT, and AMCLI Italian Societies

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-07-25 DOI:10.1111/ctr.70255

Corrado Girmenia, Tiziana Lazzarotto, Massimo Martino, Francesca Bonifazi, Fausto Baldanti, Pierangelo Clerici, Franco Citterio, Luciano De Carlis, Giovanni Barosi, Paolo Antonio Grossi

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Abstract

New options for prevention and therapy of cytomegalovirus (CMV) infection and new tests for antiviral immune reconstitution are leading to increased complexity in the management of CMV after allogeneic hematopoietic stem cell (allo-HSCT) and solid organ transplantation (SOT) recipients. To inform the optimal care of these patients, under the auspices of the Italian GITMO, SITO, SIMIT, and AMCLI transplant, infectious, and clinical microbiology societies, we updated the guidelines published in 2019. New recommendations were produced using a consensus-building methodology after a comprehensive review of articles released from 2019 to 2025 (March). Five domains and 31 key questions were selected through a series of questionnaires using a Delphi process. The recommendations on CMV management in transplant recipients were related to diagnostics, prevention, and treatment. Key recommendations include: in both allo-HSCT and SOT, donor and recipient should be evaluated for anti-CMV serological status before transplant for risk stratification; monitoring of CMV infection after transplant should be performed by assaying CMV DNAemia with real time PCR; CMV-specific cell mediated immunity should be monitored after transplantation in allo-HSCT and SOT; in CMV seropositive adult allo-HSCT recipients with negative CMV DNAemia, letermovir prophylaxis is recommended; there is no mandatory indication to universal prophylaxis in SOT recipients; preemptive antiviral therapy is recommended in patients with clinically significant CMV infection (CS-CMV-i); in patients with resistant or refractory CMV infection or disease after first-line antiviral therapy, oral maribavir is recommended as second line antiviral therapy. In conclusion, these recommendations aim to guide clinical practice and improve outcomes in this high-risk population.

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同种异体造血干细胞和实体器官移植中巨细胞病毒感染的处理：GITMO、SITO、SIMIT和AMCLI意大利学会的最新建议

预防和治疗巨细胞病毒（CMV）感染的新选择和抗病毒免疫重建的新测试导致同种异体造血干细胞（alloo - hsct）和实体器官移植（SOT）受体后巨细胞病毒管理的复杂性增加。为了告知这些患者的最佳护理，在意大利GITMO、SITO、SIMIT和AMCLI移植、感染和临床微生物学会的主持下，我们更新了2019年发布的指南。在对2019年至2025年（3月）发布的文章进行全面审查后，采用建立共识的方法提出了新的建议。采用德尔菲法，选取了5个领域和31个关键问题。对移植受者巨细胞病毒管理的建议涉及诊断、预防和治疗。主要建议包括：在同种异体造血干细胞移植和SOT中，移植前应评估供体和受体的抗巨细胞病毒血清学状态，以进行风险分层；移植后巨细胞病毒感染监测应采用实时PCR检测巨细胞病毒dna血症；同种异体造血干细胞移植和SOT移植后应监测cmv特异性细胞介导的免疫；巨细胞病毒血清阳性且巨细胞病毒dna血症阴性的成人同种异体造血干细胞移植受者，建议采用莱替韦预防；在接受SOT的人群中没有强制性的普遍预防指征；建议对临床显著的巨细胞病毒感染（CS-CMV-i）患者进行先发制人的抗病毒治疗；在一线抗病毒治疗后出现耐药或难治性巨细胞病毒感染或疾病的患者，建议口服马里巴韦作为二线抗病毒治疗。总之，这些建议旨在指导临床实践并改善这一高危人群的预后。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.