Herpesvirus infections in transplant recipients: current challenges in the clinical management of cytomegalovirus and Epstein-Barr virus infections.

Herpesvirus infections are common causes of morbidity and mortality in solid organ and haematopoietic stem cell transplant recipients. Significant scientific breakthroughs have reduced the incidence of herpesvirus infections during the early post-transplant period, but herpesvirus infections continue to impact significantly on the outcome of transplantation. Widespread and prolonged use of antiviral drugs has not eliminated the risk of cytomegalovirus (CMV) disease, but has changed its natural course by delaying its onset. Moreover, there is now increased recognition of ganciclovir (and other antiviral drug)-resistant CMV infections. By contrast, optimal preventive and treatment strategies for Epstein-Barr virus-related post-transplant lymphoproliferative disorders (PTLD) remain elusive. Recent experimental and clinical data, however, demonstrate a promising role for immunotherapy in preventing and treating PTLD. This review highlights the current challenges in managing CMV and Epstein-Barr virus infections in transplant patients.