Prevention and treatment of cytomegalovirus pneumonia in transplant recipients.

The prevention of cytomegalovirus (CMV) infection in individuals at the highest risk, such as CMV-seronegative recipients of allogeneic bone marrow transplants or of CMV-positive solid organ transplants, involves the use of blood products obtained from CMV-seronegative donors or the use of filtered blood products. In addition, the use of ganciclovir is becoming increasingly important as an early means of preventing serious disease. The options for use of ganciclovir include conventional prophylaxis early after engraftment or preemptive use after documented infection. Evidence is reviewed for selected use of this drug in only the highest-risk subjects to avoid unnecessary adverse effects. The optimal use of ganciclovir in specific patient groups needs to be evaluated, and general recommendations that fit all groups cannot be made at this time. Although the use of intravenous immunoglobulin (IVIG) in transplantation remains controversial, there is increasing evidence to support a recommendation of the use of IVIG as general support for the allogeneic bone marrow transplant recipient and of CMV antibody-enriched immunoglobulin in selected renal transplant recipients. For the treatment of CMV-associated pneumonitis, it is recommended that ganciclovir and IVIG be used in combination for the bone marrow transplant recipient and that ganciclovir be used with or without IVIG in patients in other transplantation groups.