Department of Infectious Diseases Cincinnati Children's Hospital Medical Center Cincinnati OH

Department of Pathology St Jude Children's Research Hospital Memphis TN

Department of Transplantation Medicine Oslo University Hospital University of Oslo Oslo Norway

Division of Infectious Diseases Department of Medicine Ajmera Transplant Center and University of Toronto Toronto ON Canada

Division of Infectious Diseases Oregon Health and Science University Portland OR

Infectious Diseases Service and Transplantation Center Lausanne University Hospital Lausanne Switzerland

Nephrology Division Federal University of Sao Paulo Sao Paulo Brazil

Transplant and Immunocompromised Host Service Infectious Diseases Division Massachusetts General Hospital Harvard Medical School Boston MA

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Kotton CN, Kumar D, Caliendo AM, et al. ; Transplantation Society International CMV Consensus Group. International consensus guidelines on the management of cytomegalovirus in solid organ transplantation. Transplantation. 2010;89:779–795. PubMed

Kotton CN, Kumar D, Caliendo AM, et al. ; Transplantation Society International CMV Consensus Group. Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation. 2013;96:333–360. PubMed

Kotton CN, Kumar D, Caliendo AM, et al. ; The Transplantation Society International CMV Consensus Group. The Third International Consensus Guidelines on the Management of Cytomegalovirus in Solid-organ Transplantation. Transplantation. 2018;102:900–931. PubMed

Guyatt GH, Oxman AD, Kunz R, et al. ; GRADE Working Group. Going from evidence to recommendations. BMJ. 2008;336:1049–1051. PubMed PMC

Guyatt GH, Oxman AD, Vist GE, et al. ; GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–926. PubMed PMC

Schunemann HJ, Oxman AD, Brozek J, et al. ; GRADE Working Group. Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ. 2008;336:1106–1110. PubMed PMC

Jaeschke R, Guyatt GH, Dellinger P, et al. ; GRADE Working Group. Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive. BMJ. 2008;337:a744. PubMed

Guyatt GH, Oxman AD, Kunz R, et al. ; GRADE Working Group. Incorporating considerations of resources use into grading recommendations. BMJ. 2008;336:1170–1173. PubMed PMC

Guyatt GH, Oxman AD, Kunz R, et al. ; GRADE Working Group. What is “quality of evidence” and why is it important to clinicians? BMJ. 2008;336:995–998. PubMed PMC

de Man RA, AH MB, Jonkman FA, et al. Patient to patient hepatitis B transmission during heart biopsy procedures. A report of the European Working Party on viral hepatitis in heart transplant recipients. J Hosp Infect. 1996;34:71–72. PubMed

Ljungman P, Chemaly RF, Khawaya F, et al. ; CMV Definitions Working Group of the Transplant Associated Virus Infections Forum. Consensus definitions of cytomegalovirus (CMV) infection and disease in transplant patients including resistant and refractory CMV for use in clinical trials: 2024 update from the Transplant Associated Virus Infections Forum. Clin Infect Dis. 2024;79:787–794. PubMed PMC

Razonable RR. Cytomegalovirus in solid organ transplant recipients: clinical updates, challenges and future directions. Curr Pharm Des. 2020;26:3497–3506. PubMed

Razonable RR, Humar A. Cytomegalovirus in solid organ transplant recipients—Guidelines of the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33:e13512. PubMed

Girmenia C, Lazzarotto T, Bonifazi F, et al. Assessment and prevention of cytomegalovirus infection in allogeneic hematopoietic stem cell transplant and in solid organ transplant: a multidisciplinary consensus conference by the Italian GITMO, SITO, and AMCLI societies. Clin Transplant. 2019;33:e13666. PubMed

Delforge ML, Desomberg L, Montesinos I. Evaluation of the new LIAISON PubMed

Kotton CN. CMV: prevention, diagnosis and therapy. Am J Transplant. 2013;13(Suppl 3):24–40. PubMed

Lagrou K, Bodeus M, Van Ranst M, et al. Evaluation of the new architect cytomegalovirus immunoglobulin M (IgM), IgG, and IgG avidity assays. J Clin Microbiol. 2009;47:1695–1699. PubMed PMC

Seed CR, Piscitelli LM, Maine GT, 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. Transfusion. 2009;49:134–145. PubMed

Preiksaitis JK, Sandhu J, Strautman M. 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. Transfusion. 2002;42:396–402. PubMed

Ritter M, Schmidt T, Dirks J, et al. Cytomegalovirus-specific T cells are detectable in early childhood and allow assignment of the infection status in children with passive maternal antibodies. Eur J Immunol. 2013;43:1099–1108. PubMed

Schmidt T, Ritter M, Dirks J, et al. Cytomegalovirus-specific T-cell immunity to assign the infection status in individuals with passive immunity: a proof of principle. J Clin Virol. 2012;54:272–275. PubMed

Burton CE, Sester M, Robinson JL, et al. Assigning cytomegalovirus status in children awaiting organ transplant: viral shedding, CMV-specific T cells, and CD27-CD28-CD4+ T cells. J Infect Dis. 2018;218:1205–1209. PubMed

Schmidt T, Schub D, Wolf M, et al. Comparative analysis of assays for detection of cell-mediated immunity toward cytomegalovirus and M. tuberculosis in samples from deceased organ donors. Am J Transplant. 2014;14:2159–2167. PubMed

Mayer BT, Matrajt L, Casper C, et al. Dynamics of persistent oral cytomegalovirus shedding during primary infection in Ugandan infants. J Infect Dis. 2016;214:1735–1743. PubMed PMC

Wunderlich W, Sidebottom AC, Schulte AK, et al. The use of saliva samples to test for congenital cytomegalovirus infection in newborns: examination of false-positive samples associated with donor milk use. Int J Neonatal Screen. 2023;9:46. PubMed PMC

Caliendo AM, St George K, Allega J, et al. Distinguishing cytomegalovirus (CMV) infection and disease with CMV nucleic acid assays. J Clin Microbiol. 2002;40:1581–1586. PubMed PMC

Emery VC, Sabin CA, Cope AV, et al. Application of viral-load kinetics to identify patients who develop cytomegalovirus disease after transplantation. Lancet. 2000;355:2032–2036. PubMed

Humar A, Gregson D, Caliendo AM, et al. Clinical utility of quantitative cytomegalovirus viral load determination for predicting cytomegalovirus disease in liver transplant recipients. Transplantation. 1999;68:1305–1311. PubMed

Humar A, Kumar D, Boivin G, et al. Cytomegalovirus (CMV) virus load kinetics to predict recurrent disease in solid-organ transplant patients with CMV disease. J Infect Dis. 2002;186:829–833. PubMed

Lao WC, Lee D, Burroughs AK, et al. Use of polymerase chain reaction to provide prognostic information on human cytomegalovirus disease after liver transplantation. J Med Virol. 1997;51:152–158. PubMed

Razonable RR, van Cruijsen H, Brown RA, et al. Dynamics of cytomegalovirus replication during preemptive therapy with oral ganciclovir. J Infect Dis. 2003;187:1801–1808. PubMed

Rollag H, Sagedal S, Kristiansen KI, et al. Cytomegalovirus DNA concentration in plasma predicts development of cytomegalovirus disease in kidney transplant recipients. Clin Microbiol Infect. 2002;8:431–434. PubMed

Hamprecht K, Steinmassl M, Einsele H, et al. Discordant detection of human cytomegalovirus DNA from peripheral blood mononuclear cells, granulocytes and plasma: correlation to viremia and HCMV infection. J Clin Virol. 1998;11:125–136. PubMed

Koidl C, Bozic M, Marth E, et al. Detection of CMV DNA: is EDTA whole blood superior to EDTA plasma? J Virol Methods. 2008;154:210–212. PubMed

Lisboa LF, Asberg A, Kumar D, et al. The clinical utility of whole blood versus plasma cytomegalovirus viral load assays for monitoring therapeutic response. Transplantation. 2011;91:231–236. PubMed

Razonable RR, Brown RA, Wilson J, et al. The clinical use of various blood compartments for cytomegalovirus (CMV) DNA quantitation in transplant recipients with CMV disease. Transplantation. 2002;73:968–973. PubMed

Tang W, Elmore SH, Fan H, et al. Cytomegalovirus DNA measurement in blood and plasma using Roche LightCycler CMV quantification reagents. Diagn Mol Pathol. 2008;17:166–173. PubMed

Rzepka M, Depka D, Gospodarek-Komkowska E, et al. Whole blood versus plasma samples-how does the type of specimen collected for testing affect the monitoring of cytomegalovirus viremia? Pathogens. 2022;11:1384. PubMed PMC

Lazzarotto T, Chiereghin A, Piralla A, et al. ; AMCLI-GLaIT. Kinetics of cytomegalovirus and Epstein-Barr virus DNA in whole blood and plasma of kidney transplant recipients: implications on management strategies. PLoS One. 2020;15:e0238062. PubMed PMC

Chemaly RF, Chou S, Einsele H, et al. ; Resistant Definitions Working Group of the Cytomegalovirus Drug Development Forum. Definitions of resistant and refractory cytomegalovirus infection and disease in transplant recipients for use in clinical trials. Clin Infect Dis. 2019;68:1420–1426. PubMed PMC

Ljungman P, Boeckh M, Hirsch HH, et al. ; Disease Definitions Working Group of the Cytomegalovirus Drug Development Forum. Definitions of cytomegalovirus infection and disease in transplant patients for use in clinical trials. Clin Infect Dis. 2017;64:87–91. PubMed

Navarro D, San-Juan R, Manuel O, et al. ; ESGICH CMV Survey Study Group, on behalf of the European Study Group of Infections in Compromised Hosts (ESGICH) from the Society of Clinical Microbiology and Infectious Diseases (ESCMID). Cytomegalovirus infection management in solid organ transplant recipients across European centers in the time of molecular diagnostics: an ESGICH survey. Transpl Infect Dis. 2017;19:e12773. PubMed

Sam SS, Rogers R, Ingersoll J, et al. Evaluation of performance characteristics of the Aptima CMV Quant assay for the detection and quantitation of CMV DNA in plasma samples. J Clin Microbiol. 2023;61:e0169922. PubMed PMC

Ishikawa S, Tasaki M, Saito K, et al. Long-term CMV monitoring and chronic rejection in renal transplant recipients. Front Cell Infect Microbiol. 2023;13:1190794. PubMed PMC

Ishikawa S, Tasaki M, Saito K, et al. Acquisition of antibody against cytomegalovirus after kidney transplantation in seronegative recipients. Transplant Proc. 2023;55:809–814. PubMed

Nakamura MR, Requiao-Moura LR, Gallo RM, et al. Transition from antigenemia to quantitative nucleic acid amplification testing in cytomegalovirus-seropositive kidney transplant recipients receiving preemptive therapy for cytomegalovirus infection. Sci Rep. 2022;12:12783. PubMed PMC

Fryer JF, Heath AB, Minor PD, et al. A collaborative study to establish the 1st WHO International Standard for human cytomegalovirus for nucleic acid amplification technology. Biologicals. 2016;44:242–251. PubMed

Preiksaitis JK, Hayden RT, Tong Y, et al. Are we there yet? Impact of the first international standard for cytomegalovirus DNA on the harmonization of results reported on plasma samples. Clin Infect Dis. 2016;63:583–589. PubMed

Hayden RT, Su Y, Tang L, et al. Accuracy of quantitative viral secondary standards: a re-examination. J Clin Microbiol. 2024;62:e0166923. PubMed PMC

Pang XL, Fox JD, Fenton JM, et al. ; American Society of Transplantation Infectious Diseases Community of Practice. Interlaboratory comparison of cytomegalovirus viral load assays. Am J Transplant. 2009;9:258–268. PubMed

Hayden RT, Preiksaitis J, Tong Y, et al. Commutability of the First World Health Organization International Standard for Human Cytomegalovirus. J Clin Microbiol. 2015;53:3325–3333. PubMed PMC

Hayden RT, Sun Y, Tang L, et al. Progress in quantitative viral load testing: variability and impact of the WHO quantitative international standards. J Clin Microbiol. 2017;55:423–430. PubMed PMC

Hayden RT, Yan X, Wick MT, et al. ; College of American Pathologists Microbiology Resource Committee. Factors contributing to variability of quantitative viral PCR results in proficiency testing samples: a multivariate analysis. J Clin Microbiol. 2012;50:337–345. PubMed PMC

Jones S, Webb EM, Barry CP, et al. Commutability of cytomegalovirus WHO international standard in different matrices. J Clin Microbiol. 2016;54:1512–1519. PubMed PMC

Hayden RT, Gu Z, Sam SS, et al. Comparative evaluation of three commercial quantitative cytomegalovirus standards by use of digital and real-time PCR. J Clin Microbiol. 2015;53:1500–1505. PubMed PMC

Tsai HP, Tsai YY, Lin IT, et al. Comparison of two commercial automated nucleic acid extraction and integrated quantitation real-time PCR platforms for the detection of cytomegalovirus in plasma. PLoS One. 2016;11:e0160493. PubMed PMC

Tong Y, Pang XL, Mabilangan C, et al. Determination of the biological form of human cytomegalovirus DNA in the plasma of solid-organ transplant recipients. J Infect Dis. 2017;215:1094–1101. PubMed PMC

Leuzinger K, Hirsch HH. Amplicon size and non-encapsidated DNA fragments define plasma cytomegalovirus DNA loads by automated nucleic acid testing platforms: a marker of viral cytopathology? J Med Virol. 2023;95:e29139. PubMed

Peddu V, Bradley BT, Casto AM, et al. High-resolution profiling of human cytomegalovirus cell-free DNA in human plasma highlights its exceptionally fragmented nature. Sci Rep. 2020;10:3734. PubMed PMC

Gimenez E, Gozalbo-Rovira R, Albert E, et al. Letermovir use may impact on the cytomegalovirus DNA fragmentation profile in plasma from allogeneic hematopoietic stem cell transplant recipients. J Med Virol. 2024;96:e29564. PubMed

Cassaniti I, Colombo AA, Bernasconi P, et al. Positive HCMV DNAemia in stem cell recipients undergoing letermovir prophylaxis is expression of abortive infection. Am J Transplant. 2021;21:1622–1628. PubMed

Hirsch HH, Lautenschlager I, Pinsky BA, et al. An international multicenter performance analysis of cytomegalovirus load tests. Clin Infect Dis. 2013;56:367–373. PubMed PMC

Caliendo AM, Schuurman R, Yen-Lieberman B, et al. ; CMV Working Group of the Complications of HIV Disease RAC, AIDS Clinical Trials Group. Comparison of quantitative and qualitative PCR assays for cytomegalovirus DNA in plasma. J Clin Microbiol. 2001;39:1334–1338. PubMed PMC

Lilleri D, Lazzarotto T, Ghisetti V, et al. ; SIV-AMCLI Transplant Surveillance Group. Multicenter quality control study for human cytomegalovirus DNAemia quantification. New Microbiol. 2009;32:245–253. PubMed

Abbate I, Piralla A, Calvario A, et al. ; AMCLI − Infections in Transplant Working Group GLaIT. Nation-wide measure of variability in HCMV, EBV and BKV DNA quantification among centers involved in monitoring transplanted patients. J Clin Virol. 2016;82:76–83. PubMed

Roh J, Kim S, Kwak E, et al. Performance evaluation of the Roche cobas 6800 system for quantifying cytomegalovirus DNA in plasma and urine samples. J Clin Virol. 2021;138:104816. PubMed

Madej RM, Caliendo AM, Krajden M, et al. Quantitative molecular methods for infectious diseases; approved guideline—second edition. MM6-A. NCCLS. 2003;Volume 23 Number 28. Available at https://community.clsi.org/media/1483/mm06a2_sample.pdf. Accessed March 21, 2025.

Beechar VB, Pouch SM, Phadke VK, et al. Impact of an ultrasensitive cytomegalovirus quantitative nucleic acid test on cytomegalovirus detection and therapy in renal transplant recipients. Transpl Infect Dis. 2024;26:e14219. PubMed PMC

Meesing A, Germer JJ, Yao JD, et al. Differences in duration and degree of cytomegalovirus DNAemia observed with two standardized quantitative nucleic acid tests and implications for clinical care. J Infect Dis. 2020;221:251–255. PubMed

Funk GA, Gosert R, Hirsch HH. Viral dynamics in transplant patients: implications for disease. Lancet Infect Dis. 2007;7:460–472. PubMed

Atabani SF, Smith C, Atkinson C, et al. Cytomegalovirus replication kinetics in solid organ transplant recipients managed by preemptive therapy. Am J Transplant. 2012;12:2457–2464. PubMed PMC

Lodding IP, Mocroft A, da Cunha Bang C, et al. Impact of CMV PCR blips in recipients of solid organ and hematopoietic stem cell transplantation. Transplant Direct. 2018;4:e355. PubMed PMC

Humar A, Paya C, Pescovitz MD, et al. Clinical utility of cytomegalovirus viral load testing for predicting CMV disease in D+/R- solid organ transplant recipients. Am J Transplant. 2004;4:644–649. PubMed

Dobrer S, Sherwood KR, Hirji I, et al. Viral load kinetics and the clinical consequences of cytomegalovirus in kidney transplantation. Front Immunol. 2023;14:1302627. PubMed PMC

Asberg A, Humar A, Rollag H, et al. ; VICTOR Study Group. Oral valganciclovir is noninferior to intravenous ganciclovir for the treatment of cytomegalovirus disease in solid organ transplant recipients. Am J Transplant. 2007;7:2106–2113. PubMed

Lodding IP, Sengelov H, da Cunha-Bang C, et al. ; MATCH Programme Study Group. Clinical application of variation in replication kinetics during episodes of post-transplant cytomegalovirus infections. EBioMedicine. 2015;2:699–705. PubMed PMC

Emery VC, Cope AV, Bowen EF, et al. The dynamics of human cytomegalovirus replication in vivo. J Exp Med. 1999;190:177–182. PubMed PMC

Nebbia G, Mattes FM, Cholongitas E, et al. Exploring the bidirectional interactions between human cytomegalovirus and hepatitis C virus replication after liver transplantation. Liver Transpl. 2007;13:130–135. PubMed

Piccirilli G, Lanna F, Gabrielli L, et al. CMV-RNAemia as new marker of active viral replication in transplant recipients. J Clin Microbiol. 2024;62:e0163023. PubMed PMC

Razonable RR, Hayden RT. Clinical utility of viral load in management of cytomegalovirus infection after solid organ transplantation. Clin Microbiol Rev. 2013;26:703–727. PubMed PMC

Pillay D, Ali AA, Liu SF, et al. The prognostic significance of positive CMV cultures during surveillance of renal transplant recipients. Transplantation. 1993;56:103–108. PubMed

Humar A, Limaye AP, Blumberg EA, et al. Extended valganciclovir prophylaxis in D+/R- kidney transplant recipients is associated with long-term reduction in cytomegalovirus disease: two-year results of the IMPACT study. Transplantation. 2010;90:1427–1431. PubMed

Humar A, Mazzulli T, Moussa G, et al. ; Valganciclovir Solid Organ Transplant Study Group. Clinical utility of cytomegalovirus (CMV) serology testing in high-risk CMV D+/R- transplant recipients. Am J Transplant. 2005;5:1065–1070. PubMed

Blanco-Lobo P, Bulnes-Ramos A, McConnell MJ, et al. Applying lessons learned from cytomegalovirus infection in transplant patients to vaccine design. Drug Discov Today. 2016;21:674–681. PubMed

Chemaly RF, Yen-Lieberman B, Castilla EA, et al. Correlation between viral loads of cytomegalovirus in blood and bronchoalveolar lavage specimens from lung transplant recipients determined by histology and immunohistochemistry. J Clin Microbiol. 2004;42:2168–2172. PubMed PMC

Solans EP, Yong S, Husain AN, et al. Bronchioloalveolar lavage in the diagnosis of CMV pneumonitis in lung transplant recipients: an immunocytochemical study. Diagn Cytopathol. 1997;16:350–352. PubMed

Halme L, Lempinen M, Arola J, et al. High frequency of gastroduodenal cytomegalovirus infection in liver transplant patients. APMIS. 2008;116:99–106. PubMed

Durand CM, Marr KA, Arnold CA, et al. Detection of cytomegalovirus DNA in plasma as an adjunct diagnostic for gastrointestinal tract disease in kidney and liver transplant recipients. Clin Infect Dis. 2013;57:1550–1559. PubMed PMC

Fisher CE, Alexander J, Bhattacharya R, et al. Sensitivity of blood and tissue diagnostics for gastrointestinal cytomegalovirus disease in solid organ transplant recipients. Transpl Infect Dis. 2016;18:372–380. PubMed

Eid AJ, Arthurs SK, Deziel PJ, et al. Clinical predictors of relapse after treatment of primary gastrointestinal cytomegalovirus disease in solid organ transplant recipients. Am J Transplant. 2010;10:157–161. PubMed

Taksinwarajarn T, Sobhonslidsuk A, Kantachuvesiri S, et al. ; Ramathibodi Transplant Infectious Diseases (RTID) Group. Role of highly sensitive nucleic acid amplification testing for plasma cytomegalovirus DNA load in diagnosis of cytomegalovirus gastrointestinal disease among kidney transplant recipients. Transpl Infect Dis. 2021;23:e13635. PubMed

Alacam S, Karabulut N, Bakir A, et al. Diagnostic significance of cytomegalovirus DNA quantitation in gastrointestinal biopsies: comparison with histopathological data and blood cytomegalovirus DNA. Eur J Gastroenterol Hepatol. 2021;33:40–45. PubMed

Suarez-Lledo M, Marcos MA, Cuatrecasas M, et al. Quantitative PCR is faster, more objective, and more reliable than immunohistochemistry for the diagnosis of cytomegalovirus gastrointestinal disease in allogeneic stem cell transplantation. Biol Blood Marrow Transplant. 2019;25:2281–2286. PubMed

McCoy MH, Post K, Sen JD, et al. qPCR increases sensitivity to detect cytomegalovirus in formalin-fixed, paraffin-embedded tissue of gastrointestinal biopsies. Hum Pathol. 2014;45:48–53. PubMed

Mills AM, Guo FP, Copland AP, et al. A comparison of CMV detection in gastrointestinal mucosal biopsies using immunohistochemistry and PCR performed on formalin-fixed, paraffin-embedded tissue. Am J Surg Pathol. 2013;37:995–1000. PubMed

Westall GP, Michaelides A, Williams TJ, et al. Human cytomegalovirus load in plasma and bronchoalveolar lavage fluid: a longitudinal study of lung transplant recipients. J Infect Dis. 2004;190:1076–1083. PubMed

Kerschner H, Jaksch P, Zweytick B, et al. Detection of human cytomegalovirus in bronchoalveolar lavage fluid of lung transplant recipients reflects local virus replication and not contamination from the throat. J Clin Microbiol. 2010;48:4273–4274. PubMed PMC

Beam E, Lesnick T, Kremers W, et al. Cytomegalovirus disease is associated with higher all-cause mortality after lung transplantation despite extended antiviral prophylaxis. Clin Transplant. 2016;30:270–278. PubMed

Bauer CC, Jaksch P, Aberle SW, et al. Relationship between cytomegalovirus DNA load in epithelial lining fluid and plasma of lung transplant recipients and analysis of coinfection with Epstein-Barr virus and human herpesvirus 6 in the lung compartment. J Clin Microbiol. 2007;45:324–328. PubMed PMC

Gerna G, Lilleri D, Rognoni V, et al. Preemptive therapy for systemic and pulmonary human cytomegalovirus infection in lung transplant recipients. Am J Transplant. 2009;9:1142–1150. PubMed

Riise GC, Andersson R, Bergstrom T, et al. Quantification of cytomegalovirus DNA in BAL fluid: a longitudinal study in lung transplant recipients. Chest. 2000;118:1653–1660. PubMed

Chemaly RF, Yen-Lieberman B, Chapman J, et al. Clinical utility of cytomegalovirus viral load in bronchoalveolar lavage in lung transplant recipients. Am J Transplant. 2005;5:544–548. PubMed

Lodding IP, Schultz HH, Jensen JU, et al. Cytomegalovirus viral load in bronchoalveolar lavage to diagnose lung transplant associated CMV pneumonia. Transplantation. 2018;102:326–332. PubMed

Beam E, Germer JJ, Lahr B, et al. Cytomegalovirus (CMV) DNA quantification in bronchoalveolar lavage fluid of immunocompromised patients with CMV pneumonia. Clin Transplant. 2018;32:e13149. PubMed

Puchhammer-Stockl E. Herpesviruses and the transplanted lung: looking at the air side. J Clin Virol. 2008;43:415–418. PubMed

Leuzinger K, Stolz D, Gosert R, et al. Comparing cytomegalovirus diagnostics by cell culture and quantitative nucleic acid testing in broncho-alveolar lavage fluids. J Med Virol. 2021;93:3804–3812. PubMed

Laub MR, Byrns J, Gommer J, et al. Delayed vs initial cytomegalovirus prophylaxis after kidney transplantation. Clin Transplant. 2020;34:e13854. PubMed

Magid M, Byrns J, Gommer J, et al. Early versus delayed initiation of cytomegalovirus prophylaxis after liver transplant. Pharmacotherapy. 2022;42:634–640. PubMed PMC

Rubin RH, Kemmerly SA, Conti D, et al. Prevention of primary cytomegalovirus disease in organ transplant recipients with oral ganciclovir or oral acyclovir prophylaxis. Transpl Infect Dis. 2000;2:112–117. PubMed

Paya C, Humar A, Dominguez E, et al. ; Valganciclovir Solid Organ Transplant Study Group. Efficacy and safety of valganciclovir vs. oral ganciclovir for prevention of cytomegalovirus disease in solid organ transplant recipients. Am J Transplant. 2004;4:611–620. PubMed

Katada Y, Nakagawa S, Nagao M, et al. Trough ganciclovir concentration as predictor of leukopenia in lung transplant recipients receiving valganciclovir prophylaxis. Transpl Infect Dis. 2023;25:e14141. PubMed

Lowance D, Neumayer HH, Legendre CM, et al. Valacyclovir for the prevention of cytomegalovirus disease after renal transplantation. International Valacyclovir Cytomegalovirus Prophylaxis Transplantation Study Group. N Engl J Med. 1999;340:1462–1470. PubMed

Hodson EM, Ladhani M, Webster AC, et al. Antiviral medications for preventing cytomegalovirus disease in solid organ transplant recipients. Cochrane Database Syst Rev. 2013;2:CD003774. PubMed

Reischig T, Jindra P, Mares J, et al. Valacyclovir for cytomegalovirus prophylaxis reduces the risk of acute renal allograft rejection. Transplantation. 2005;79:317–324. PubMed

Pavlopoulou ID, Syriopoulou VP, Chelioti H, et al. A comparative randomised study of valacyclovir vs. oral ganciclovir for cytomegalovirus prophylaxis in renal transplant recipients. Clin Microbiol Infect. 2005;11:736–743. PubMed

Reischig T, Kacer M, Jindra P, et al. Randomized trial of valganciclovir versus valacyclovir prophylaxis for prevention of cytomegalovirus in renal transplantation. Clin J Am Soc Nephrol. 2015;10:294–304. PubMed PMC

Verghese PS, Evans MD, Hanson A, et al. Valacyclovir or valganciclovir for cytomegalovirus prophylaxis: a randomized controlled trial in adult and pediatric kidney transplant recipients. J Clin Virol. 2024;172:105678. PubMed

Vernooij RW, Michael M, Ladhani M, et al. Antiviral medications for preventing cytomegalovirus disease in solid organ transplant recipients. Cochrane Database Syst Rev. 2024;5:CD003774. PubMed PMC

Reischig T, Kacer M, Hruba P, et al. Less renal allograft fibrosis with valganciclovir prophylaxis for cytomegalovirus compared to high-dose valacyclovir: a parallel group, open-label, randomized controlled trial. BMC Infect Dis. 2018;18:573. PubMed PMC

Kacer M, Kielberger L, Bouda M, et al. Valganciclovir versus valacyclovir prophylaxis for prevention of cytomegalovirus: an economic perspective. Transpl Infect Dis. 2015;17:334–341. PubMed

Lischka P, Michel D, Zimmermann H. Characterization of cytomegalovirus breakthrough events in a phase 2 prophylaxis trial of letermovir (AIC246, MK 8228). J Infect Dis. 2016;213:23–30. PubMed

Limaye AP, Budde K, Humar A, et al. Letermovir vs valganciclovir for prophylaxis of cytomegalovirus in high-risk kidney transplant recipients: a randomized clinical trial. JAMA. 2023;330:33–42. PubMed PMC

Jorgenson MR, Descourouez JL, Saddler CM, et al. Real world experience with conversion from valganciclovir to letermovir for cytomegalovirus prophylaxis: letermovir reverses leukopenia and avoids mycophenolate dose reduction. Clin Transplant. 2023;37:e15142. PubMed

Ibrahim D, Byrns J, Maziarz E, et al. Use of letermovir for primary and secondary cytomegalovirus prophylaxis in abdominal organ transplantation: a single center experience. J Pharm Pract. 2024;37:770–779. PubMed

Winstead RJ, Kumar D, Brown A, et al. Letermovir prophylaxis in solid organ transplant—assessing CMV breakthrough and tacrolimus drug interaction. Transpl Infect Dis. 2021;23:e13570. PubMed

Martinez S, Sindu D, Nailor MD, et al. Evaluating the efficacy and safety of letermovir compared to valganciclovir for the prevention of human cytomegalovirus disease in adult lung transplant recipients. Transpl Infect Dis. 2024;26:e14279. PubMed

Kleiboeker HL, Wang J, Borkowski N, et al. Use of letermovir for cytomegalovirus primary prophylaxis in lung transplant recipients. Transpl Infect Dis. 2024;26:e14337. PubMed

Saltiel G, Faure E, Assaf A, et al. Real-life use of letermovir prophylaxis for cytomegalovirus in heart transplant recipients. Clin Transplant. 2024;38:e15327. PubMed

Saullo JL, Miller RA. Cytomegalovirus therapy: role of letermovir in prophylaxis and treatment in transplant recipients. Annu Rev Med. 2023;74:89–105. PubMed

Golob S, Batra J, DeFilippis EM, et al. Letermovir for cytomegalovirus prophylaxis in high-risk heart transplant recipients. Clin Transplant. 2022;36:e14808. PubMed

Aryal S, Katugaha SB, Cochrane A, et al. Single-center experience with use of letermovir for CMV prophylaxis or treatment in thoracic organ transplant recipients. Transpl Infect Dis. 2019;21:e13166. PubMed

Humar A, Lebranchu Y, Vincenti F, et al. The efficacy and safety of 200 days valganciclovir cytomegalovirus prophylaxis in high-risk kidney transplant recipients. Am J Transplant. 2010;10:1228–1237. PubMed

Razonable RR, Rivero A, Rodriguez A, 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. J Infect Dis. 2001;184:1461–1464. PubMed

Schoeppler KE, Lyu DM, Grazia TJ, et al. Late-onset cytomegalovirus (CMV) in lung transplant recipients: can CMV serostatus guide the duration of prophylaxis? Am J Transplant. 2013;13:376–382. PubMed

Hashim F, Gregg JA, Dharnidharka VR. Efficacy of extended valganciclovir prophylaxis in preventing cytomegalovirus infection in pediatric kidney transplantation. Open Urol Nephrol J. 2014;7(Suppl 2 M7):152–157. PubMed PMC

Palmer SM, Limaye AP, Banks M, et al. Extended valganciclovir prophylaxis to prevent cytomegalovirus after lung transplantation: a randomized, controlled trial. Ann Intern Med. 2010;152:761–769. PubMed

Herrera S, Khan B, Singer LG, et al. Extending cytomegalovirus prophylaxis in high-risk (D+/R-) lung transplant recipients from 6 to 9 months reduces cytomegalovirus disease: a retrospective study. Transpl Infect Dis. 2020;22:e13277. PubMed

Paraskeva M, Bailey M, Levvey BJ, et al. Cytomegalovirus replication within the lung allograft is associated with bronchiolitis obliterans syndrome. Am J Transplant. 2011;11:2190–2196. PubMed

Zamora MR, Nicolls MR, Hodges TN, et al. Following universal prophylaxis with intravenous ganciclovir and cytomegalovirus immune globulin, valganciclovir is safe and effective for prevention of CMV infection following lung transplantation. Am J Transplant. 2004;4:1635–1642. PubMed

Jaksch P, Zweytick B, Kerschner H, et al. Cytomegalovirus prevention in high-risk lung transplant recipients: comparison of 3- vs 12-month valganciclovir therapy. J Heart Lung Transplant. 2009;28:670–675. PubMed

Wiita AP, Roubinian N, Khan Y, et al. Cytomegalovirus disease and infection in lung transplant recipients in the setting of planned indefinite valganciclovir prophylaxis. Transpl Infect Dis. 2012;14:248–258. PubMed

Couzi L, Helou S, Bachelet T, et al. High incidence of anticytomegalovirus drug resistance among D+R- kidney transplant recipients receiving preemptive therapy. Am J Transplant. 2012;12:202–209. PubMed

Sun HY, Cacciarelli TV, Wagener MM, et al. Preemptive therapy for cytomegalovirus based on real-time measurement of viral load in liver transplant recipients. Transpl Immunol. 2010;23:166–169. PubMed

Singh N, Winston DJ, Razonable RR, et al. Effect of preemptive therapy vs antiviral prophylaxis on cytomegalovirus disease in seronegative liver transplant recipients with seropositive donors: a randomized clinical trial. JAMA. 2020;323:1378–1387. PubMed PMC

Doss KM, Kling CE, Heldman MR, et al. Real-world effectiveness of preemptive therapy (PET) for cytomegalovirus (CMV) disease prevention in CMV high-risk donor seropositive/recipient seronegative (D+R-) liver transplant recipients (LTxR). Transpl Infect Dis. 2023;25:e14015. PubMed

Witzke O, Nitschke M, Bartels M, et al. Valganciclovir prophylaxis versus preemptive therapy in cytomegalovirus-positive renal allograft recipients: long-term results after 7 years of a randomized clinical trial. Transplantation. 2018;102:876–882. PubMed

Montero C, Yomayusa N, Torres R, et al. Low dose thymoglobulin versus basiliximab in cytomegalovirus positive kidney transplant recipients: effectiveness of preemptive cytomegalovirus modified strategy. Nefrologia. 2023;43:213–223. PubMed

Fernandez-Garcia OA, Garcia-Juarez I, Belaunzaran-Zamudio PF, et al. Incidence of cytomegalovirus disease and viral replication kinetics in seropositive liver transplant recipients managed under preemptive therapy in a tertiary-care center in Mexico City: a retrospective cohort study. BMC Infect Dis. 2022;22:155. PubMed PMC

Dheerasekara K, Tharanga R, Rajamanthri L, et al. The pattern of cytomegalovirus replication in post-renal transplant recipients with pre-emptive therapy strategy during the 1(st) year of post-transplantation. Int J Health Sci. 2023;17:39–44. PubMed PMC

Lerman JB, Green CL, Molina MR, et al. Multicenter study of universal prophylaxis versus pre-emptive therapy for patients at intermediate risk (R+) for CMV following heart transplantation. Clin Transplant. 2023;37:e15065. PubMed PMC

Reischig T, Vlas T, Kacer M, et al. A randomised trial of valganciclovir prophylaxis versus preemptive therapy in kidney transplant recipients. J Am Soc Nephrol. 2023;34:920–934. PubMed PMC

Lumley S, Green C, Rafferty H, et al. Cytomegalovirus viral load parameters associated with earlier initiation of pre-emptive therapy after solid organ transplantation. PLoS One. 2019;14:e0210420. PubMed PMC

Ono G, Medina Pestana JO, Aranha Camargo LF. Late cytomegalovirus (CMV) infections after kidney transplantation under the preemptive strategy: risk factors and clinical aspects. Transpl Infect Dis. 2019;21:e13035. PubMed

Felipe C, Ferreira AN, de Paula M, et al. Incidence and risk factors associated with cytomegalovirus infection after the treatment of acute rejection during the first year in kidney transplant recipients receiving preemptive therapy. Transpl Infect Dis. 2019;21:e13106. PubMed

Piloni D, Gabanti E, Morosini M, et al. Fifteen-year surveillance of LTR receiving pre-emptive therapy for CMV infection: prevention of CMV disease and incidence of CLAD. Microorgan. 2022;10:2339. PubMed PMC

Blom KB, Birkeland GK, Midtvedt K, et al. Cytomegalovirus high-risk kidney transplant recipients show no difference in long-term outcomes following preemptive versus prophylactic management. Transplantation. 2023;107:1846–1853. PubMed PMC

Chanburanavah N, Boonsathorn S, Apiwattanakul N, et al. Risk factors of cytomegalovirus infection after pediatric liver transplantation and effectiveness of preemptive therapy. Transpl Infect Dis. 2023;25:e14057. PubMed

Khoury JA, Storch GA, Bohl DL, et al. Prophylactic versus preemptive oral valganciclovir for the management of cytomegalovirus infection in adult renal transplant recipients. Am J Transplant. 2006;6:2134–2143. PubMed

Reischig T, Jindra P, Hes O, et al. Valacyclovir prophylaxis versus preemptive valganciclovir therapy to prevent cytomegalovirus disease after renal transplantation. Am J Transplant. 2008;8:69–77. PubMed

Kliem V, Fricke L, Wollbrink T, et al. Improvement in long-term renal graft survival due to CMV prophylaxis with oral ganciclovir: results of a randomized clinical trial. Am J Transplant. 2008;8:975–983. PubMed

Witzke O, Hauser IA, Bartels M, et al. ; VIPP Study Group. Valganciclovir prophylaxis versus preemptive therapy in cytomegalovirus-positive renal allograft recipients: 1-year results of a randomized clinical trial. Transplantation. 2012;93:61–68. PubMed

Asberg A, Humar A, Jardine AG, et al. ; VICTOR Study Group. Long-term outcomes of CMV disease treatment with valganciclovir versus IV ganciclovir in solid organ transplant recipients. Am J Transplant. 2009;9:1205–1213. PubMed

Ramanan P, Razonable RR. Cytomegalovirus infections in solid organ transplantation: a review. Infect Chemother. 2013;45:260–271. PubMed PMC

Reischig T, Nemcova J, Vanecek T, et al. Intragraft cytomegalovirus infection: a randomized trial of valacyclovir prophylaxis versus pre-emptive therapy in renal transplant recipients. Antivir Ther. 2010;15:23–30. PubMed

Spinner ML, Saab G, Casabar E, et al. Impact of prophylactic versus preemptive valganciclovir on long-term renal allograft outcomes. Transplantation. 2010;90:412–418. PubMed PMC

Reischig T, Kacer M, Hruba P, et al. The impact of viral load and time to onset of cytomegalovirus replication on long-term graft survival after kidney transplantation. Antivir Ther. 2017;22:503–513. PubMed

Manuel O, Kralidis G, Mueller NJ, et al. ; Swiss Transplant Cohort Study. Impact of antiviral preventive strategies on the incidence and outcomes of cytomegalovirus disease in solid organ transplant recipients. Am J Transplant. 2013;13:2402–2410. PubMed

Reischig T, Hribova P, Jindra P, et al. Long-term outcomes of pre-emptive valganciclovir compared with valacyclovir prophylaxis for prevention of cytomegalovirus in renal transplantation. J Am Soc Nephrol. 2012;23:1588–1597. PubMed PMC

Singh N, Winston DJ, Razonable RR, et al. Cost-effectiveness of preemptive therapy versus prophylaxis in a randomized clinical trial for the prevention of cytomegalovirus disease in seronegative liver transplant recipients with seropositive donors. Clin Infect Dis. 2021;73:e2739–e2745. PubMed PMC

Kumar L, Dasgupta S, Murray-Krezan C, et al. Association of cytomegalovirus (CMV) DNAemia with long-term mortality in a randomized trial of preemptive therapy and antiviral prophylaxis for prevention of CMV disease in high-risk donor seropositive, recipient seronegative liver transplant recipients. Clin Infect Dis. 2024;78:719–722. PubMed PMC

Camus C, Poinot M, Pronier C, et al. Comparison of prophylaxis and preemptive strategy as cytomegalovirus prevention in liver transplant recipients. Transpl Infect Dis. 2024;26:e14282. PubMed

Owers DS, Webster AC, Strippoli GF, et al. Pre-emptive treatment for cytomegalovirus viraemia to prevent cytomegalovirus disease in solid organ transplant recipients. Cochrane Database Syst Rev. 2013;2013:CD005133. PubMed PMC

Florescu DF, Qiu F, Schmidt CM, et al. A direct and indirect comparison meta-analysis on the efficacy of cytomegalovirus preventive strategies in solid organ transplant. Clin Infect Dis. 2014;58:785–803. PubMed

Mumtaz K, Faisal N, Husain S, et al. Universal prophylaxis or preemptive strategy for cytomegalovirus disease after liver transplantation: a systematic review and meta-analysis. Am J Transplant. 2015;15:472–481. PubMed

Yadav DK, Adhikari VP, Yadav RK, et al. Antiviral prophylaxis or preemptive therapy for cytomegalovirus after liver transplantation?: a systematic review and meta-analysis. Front Immunol. 2022;13:953210. PubMed PMC

Hui Y, Xiangli C, Xin W, et al. Clinical outcomes with antiviral prophylaxis or preemptive therapy for cytomegalovirus disease after liver transplantation: a systematic review and meta-analysis. J Pharm Pharm Sci. 2017;20:15–27. PubMed

Raza H, Li S, Zhou Q, et al. Effects of ultrasound-induced V-type rice starch-tannic acid interactions on starch in vitro digestion and multiscale structural properties. Int J Biol Macromol. 2023;246:125619. PubMed

Snyder LD, Finlen-Copeland CA, Turbyfill WJ, et al. Cytomegalovirus pneumonitis is a risk for bronchiolitis obliterans syndrome in lung transplantation. Am J Respir Crit Care Med. 2010;181:1391–1396. PubMed PMC

Zuk DM, Humar A, Weinkauf JG, et al. An international survey of cytomegalovirus management practices in lung transplantation. Transplantation. 2010;90:672–676. PubMed

Lisboa LF, Preiksaitis JK, Humar A, et al. Clinical utility of molecular surveillance for cytomegalovirus after antiviral prophylaxis in high-risk solid organ transplant recipients. Transplantation. 2011;92:1063–1068. PubMed

Montejo M, Montejo E, Gastaca M, et al. Prophylactic therapy with valgancyclovir in high-risk (cytomegalovirus D+/R-) liver transplant recipients: a single-center experience. Transplant Proc. 2009;41:2189–2191. PubMed

Boillat Blanco N, Pascual M, Venetz JP, et al. Impact of a preemptive strategy after 3 months of valganciclovir cytomegalovirus prophylaxis in kidney transplant recipients. Transplantation. 2011;91:251–255. PubMed

van der Beek MT, Berger SP, Vossen AC, et al. Preemptive versus sequential prophylactic-preemptive treatment regimens for cytomegalovirus in renal transplantation: comparison of treatment failure and antiviral resistance. Transplantation. 2010;89:320–326. PubMed

Valencia Deray KG, Hosek KE, Chilukuri D, et al. Epidemiology and long-term outcomes of cytomegalovirus DNAemia and disease in pediatric solid organ transplant recipients. Am J Transplant. 2022;22:187–198. PubMed

Raiha J, Ortiz F, Mannonen L, et al. The burden of cytomegalovirus infection remains high in high-risk kidney transplant recipients despite six-month valganciclovir prophylaxis. Transpl Infect Dis. 2021;23:e13577. PubMed

Fernandez-Garcia OA, Hernandez C, Robbins M, et al. Cytomegalovirus surveillance after antiviral prophylaxis in CMV mismatched transplant patients: does recurrent cytomegalovirus DNAemia impact patient survival? Transpl Infect Dis. 2024;26:e14292. PubMed

Immohr MB, Oehler D, Jenkins FS, et al. Evaluation of risk factors for cytomegalovirus DNAemia after end of regular prophylaxis after heart transplantation. Immun Inflamm Dis. 2023;11:e1075. PubMed PMC

Non LR, Tan CS, Ince D, et al. Survey of post-prophylaxis delayed-onset cytomegalovirus management strategies among transplant providers. Clin Transplant. 2024;38:e70015. PubMed

Vinuesa V, Gimenez E, Solano C, et al. Would kinetic analyses of plasma cytomegalovirus DNA load help to reach consensus criteria for triggering the initiation of preemptive antiviral therapy in transplant recipients? Clin Infect Dis. 2016;63:1533–1535. PubMed

Solano C, Gimenez E, Pinana JL, et al. Preemptive antiviral therapy for CMV infection in allogeneic stem cell transplant recipients guided by the viral doubling time in the blood. Bone Marrow Transplant. 2016;51:718–721. PubMed

Gimenez E, Munoz-Cobo B, Solano C, et al. Early kinetics of plasma cytomegalovirus DNA load in allogeneic stem cell transplant recipients in the era of highly sensitive real-time PCR assays: does it have any clinical value? J Clin Microbiol. 2014;52:654–656. PubMed PMC

Emery VC, Hassan-Walker AF, Burroughs AK, et al. Human cytomegalovirus (HCMV) replication dynamics in HCMV-naive and -experienced immunocompromised hosts. J Infect Dis. 2002;185:1723–1728. PubMed

Martin-Gandul C, Perez-Romero P, Blanco-Lobo P, et al. ; Spanish Network for Research in Infectious Diseases (REIPI). Viral load, CMV-specific T-cell immune response and cytomegalovirus disease in solid organ transplant recipients at higher risk for cytomegalovirus infection during preemptive therapy. Transpl Int. 2014;27:1060–1068. PubMed

Natori Y, Humar A, Husain S, et al. Recurrence of CMV infection and the effect of prolonged antivirals in organ transplant recipients. Transplantation. 2017;101:1449–1454. PubMed

Sullivan T, Brodginski A, Patel G, et al. The role of secondary cytomegalovirus prophylaxis for kidney and liver transplant recipients. Transplantation. 2015;99:855–859. PubMed

Helantera I, Lautenschlager I, Koskinen P. The risk of cytomegalovirus recurrence after kidney transplantation. Transpl Int. 2011;24:1170–1178. PubMed

Kumar D, Mian M, Singer L, et al. An interventional study using cell-mediated immunity to personalize therapy for cytomegalovirus infection after transplantation. Am J Transplant. 2017;17:2468–2473. PubMed

Nafar M, Roshan A, Pour-Reza-Gholi F, et al. Prevalence and risk factors of recurrent cytomegalovirus infection in kidney transplant recipients. Iran J Kidney Dis. 2014;8:231–235. PubMed

Gardiner BJ, Chow JK, Brilleman SL, et al. The impact of recurrent cytomegalovirus infection on long-term survival in solid organ transplant recipients. Transpl Infect Dis. 2019;21:e13189. PubMed

Gardiner BJ, Nierenberg NE, Chow JK, et al. Absolute lymphocyte count: a predictor of recurrent cytomegalovirus disease in solid organ transplant recipients. Clin Infect Dis. 2018;67:1395–1402. PubMed PMC

Chong PP, Teiber D, Prokesch BC, et al. Letermovir successfully used for secondary prophylaxis in a heart transplant recipient with ganciclovir-resistant cytomegalovirus syndrome (UL97 mutation). Transpl Infect Dis. 2018;20:e12965. PubMed

Moreno A, Cervera C, Fortun J, et al. ; OLT-HIV FIPSE Cohort Investigators. Epidemiology and outcome of infections in human immunodeficiency virus/hepatitis C virus-coinfected liver transplant recipients: a FIPSE/GESIDA prospective cohort study. Liver Transpl. 2012;18:70–81. PubMed

Lee YM, Kim YH, Han DJ, et al. Cytomegalovirus infection after acute rejection therapy in seropositive kidney transplant recipients. Transpl Infect Dis. 2014;16:397–402. PubMed

Santos CA, Brennan DC, Fraser VJ, et al. Delayed-onset cytomegalovirus disease coded during hospital readmission after kidney transplantation. Transplantation. 2014;98:187–194. PubMed PMC

Karadkhele G, Hogan J, Magua W, et al. CMV high-risk status and posttransplant outcomes in kidney transplant recipients treated with belatacept. Am J Transplant. 2021;21:208–221. PubMed

Petrossian G, Ortiz J, Ortiz AC, et al. Increased CMV disease and “severe” BK viremia with belatacept vs. sirolimus three-drug maintenance immunosuppression. Transpl Immunol. 2023;79:101857. PubMed

Rahimishahmirzadi M, Jevnikar AM, House AA, et al. Late-onset allograft rejection, cytomegalovirus infection, and renal allograft loss: is anti-CMV prophylaxis required following late-onset allograft rejection? Clin Transplant. 2021;35:e14285. PubMed

Magua W, Johnson AC, Karadkhele GM, et al. Impact of belatacept and tacrolimus on cytomegalovirus viral load control and relapse in moderate and high-risk cytomegalovirus serostatus kidney transplant recipients. Transpl Infect Dis. 2022;24:e13983. PubMed PMC

Los-Arcos I, Len O, Perello M, et al. Is antibody-mediated rejection in kidney transplant recipients a risk factor for developing cytomegalovirus or BK virus infection? Results from a case-control study. J Clin Virol. 2019;110:45–50. PubMed

Le Page AK, Jager MM, Kotton CN, et al. International survey of cytomegalovirus management in solid organ transplantation after the publication of consensus guidelines. Transplantation. 2013;95:1455–1460. PubMed

Chamberlain CE, Penzak SR, Alfaro RM, et al. Pharmacokinetics of low and maintenance dose valganciclovir in kidney transplant recipients. Am J Transplant. 2008;8:1297–1302. PubMed PMC

Pescovitz MD, Rabkin J, Merion RM, et al. Valganciclovir results in improved oral absorption of ganciclovir in liver transplant recipients. Antimicrob Agents Chemother. 2000;44:2811–2815. PubMed PMC

Stevens DR, Sawinski D, Blumberg E, et al. Increased risk of breakthrough infection among cytomegalovirus donor-positive/recipient-negative kidney transplant recipients receiving lower-dose valganciclovir prophylaxis. Transpl Infect Dis. 2015;17:163–173. PubMed

Gabardi S, Asipenko N, Fleming J, et al. Evaluation of low- versus high-dose valganciclovir for prevention of cytomegalovirus disease in high-risk renal transplant recipients. Transplantation. 2015;99:1499–1505. PubMed

Heldenbrand S, Li C, Cross RP, et al. Multicenter evaluation of efficacy and safety of low-dose versus high-dose valganciclovir for prevention of cytomegalovirus disease in donor and recipient positive (D+/R+) renal transplant recipients. Transpl Infect Dis. 2016;18:904–912. PubMed

Khurana MP, Lodding IP, Mocroft A, et al. Risk factors for failure of primary (val)ganciclovir prophylaxis against cytomegalovirus infection and disease in solid organ transplant recipients. Open Forum Infect Dis. 2019;6:ofz215. PubMed PMC

Shi Y, Lerner AH, Rogers R, et al. Low-dose valganciclovir prophylaxis is safe and cost-saving in CMV-seropositive kidney transplant recipients. Prog Transplant. 2021;31:368–376. PubMed

Lee JH, Kim HY, Lee DY, et al. Efficacy and safety of ultra-low-dose valganciclovir chemoprophylaxis for cytomegalovirus infection in high-risk kidney transplantation patients. Transplant Proc. 2019;51:2689–2692. PubMed

Korneffel K, Mitro G, Buschor K, et al. Low dose valganciclovir as cytomegalovirus prophylaxis in post-renal transplant recipients induced with alemtuzumab: a single-center study. Transpl Immunol. 2019;56:101226. PubMed

Halim MA, Al-Otaibi T, Gheith O, et al. Efficacy and safety of low-dose versus standard-dose valganciclovir for prevention of cytomegalovirus disease in intermediate-risk kidney transplant recipients. Exp Clin Transplant. 2016;14:526–534. PubMed

Rissling O, Naik M, Brakemeier S, et al. High frequency of valganciclovir underdosing for cytomegalovirus prophylaxis after renal transplantation. Clin Kidney J. 2018;11:564–573. PubMed PMC

Wong DD, van Zuylen WJ, Novos T, et al. Detection of ganciclovir-resistant cytomegalovirus in a prospective cohort of kidney transplant recipients receiving subtherapeutic valganciclovir prophylaxis. Microbiol Spectr. 2022;10:e0268421. PubMed PMC

Bixby AL, Fitzgerald L, Park JM, et al. Comparison of standard versus low-dose valganciclovir regimens for cytomegalovirus prophylaxis in high-risk liver transplant recipients. Transpl Infect Dis. 2021;23:e13713. PubMed

Hunt J, Chapple KM, Nasar A, et al. Efficacy of low-dose valganciclovir in CMV R+ lung transplant recipients: a retrospective comparative analysis. Multidiscip Respir Med. 2021;16:706. PubMed PMC

Eriksson M, Jokinen JJ, Soderlund S, et al. Low-dose valganciclovir prohylaxis is efficacious and safe in cytomegalovirus seropositive heart transplant recipients with anti-thymocyte globulin. Transpl Infect Dis. 2018;20:e12868. PubMed

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Snydman DR, Werner BG, Dougherty NN, et al. ; Boston Center for Liver Transplantation CMVIG Study Group. Cytomegalovirus immune globulin prophylaxis in liver transplantation. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 1993;119:984–991. PubMed

Snydman DR, Werner BG, Heinze-Lacey B, et al. Use of cytomegalovirus immune globulin to prevent cytomegalovirus disease in renal-transplant recipients. N Engl J Med. 1987;317:1049–1054. PubMed

Germer M, Herbener P, Schuttrumpf J. Functional properties of human cytomegalovirus hyperimmunoglobulin and standard immunoglobulin preparations. Ann Transplant. 2016;21:558–564. PubMed

Miescher SM, Huber TM, Kuhne M, et al. In vitro evaluation of cytomegalovirus-specific hyperimmune globulins vs. standard intravenous immunoglobulins. Vox Sang. 2015;109:71–78. PubMed

Barten MJ, Baldanti F, Staus A, et al. Effectiveness of prophylactic human cytomegalovirus hyperimmunoglobulin in preventing cytomegalovirus infection following transplantation: a systematic review and meta-analysis. Life. 2022;12:361. PubMed PMC

Florescu DF, Abu-Elmagd K, Mercer DF, et al. An international survey of cytomegalovirus prevention and treatment practices in intestinal transplantation. Transplantation. 2014;97:78–82. PubMed

Valantine HA, Luikart H, Doyle R, et al. Impact of cytomegalovirus hyperimmune globulin on outcome after cardiothoracic transplantation: a comparative study of combined prophylaxis with CMV hyperimmune globulin plus ganciclovir versus ganciclovir alone. Transplantation. 2001;72:1647–1652. PubMed

Ruttmann E, Geltner C, Bucher B, et al. Combined CMV prophylaxis improves outcome and reduces the risk for bronchiolitis obliterans syndrome (BOS) after lung transplantation. Transplantation. 2006;81:1415–1420. PubMed

Rubin RH, Lynch P, Pasternack MS, et al. Combined antibody and ganciclovir treatment of murine cytomegalovirus-infected normal and immunosuppressed BALB/c mice. Antimicrob Agents Chemother. 1989;33:1975–1979. PubMed PMC

Yamani MH, Avery R, Mawhorter SD, et al. The impact of CytoGam on cardiac transplant recipients with moderate hypogammaglobulinemia: a randomized single-center study. J Heart Lung Transplant. 2005;24:1766–1769. PubMed

Andrassy J, Hoffmann VS, Rentsch M, et al. Is cytomegalovirus prophylaxis dispensable in patients receiving an mTOR inhibitor-based immunosuppression? A systematic review and meta-analysis. Transplantation. 2012;94:1208–1217. PubMed

Su L, Tam N, Deng R, et al. Everolimus-based calcineurin-inhibitor sparing regimens for kidney transplant recipients: a systematic review and meta-analysis. Int Urol Nephrol. 2014;46:2035–2044. PubMed

Mallat SG, Tanios BY, Itani HS, et al. CMV and BKPyV infections in renal transplant recipients receiving an mTOR inhibitor-based regimen versus a CNI-based regimen: a systematic review and meta-analysis of randomized, controlled trials. Clin J Am Soc Nephrol. 2017;12:1321–1336. PubMed PMC

He L, Deng J, Yang B, et al. Efficacy and safety of everolimus plus low-dose calcineurin inhibitor vs. mycophenolate mofetil plus standard-dose calcineurin inhibitor in renal transplant recipients: a systematic review and meta-analysis. Clin Nephrol. 2018;89:336–344. PubMed

Hahn D, Hodson EM, Hamiwka LA, et al. Target of rapamycin inhibitors (TOR-I; sirolimus and everolimus) for primary immunosuppression in kidney transplant recipients. Cochrane Database Syst Rev. 2019;12:CD004290. PubMed PMC

Wolf S, Lauseker M, Schiergens T, et al. Infections after kidney transplantation: a comparison of mTOR-Is and CNIs as basic immunosuppressants. A systematic review and meta-analysis. Transpl Infect Dis. 2020;22:e13267. PubMed

Ueyama H, Kuno T, Takagi H, et al. Maintenance immunosuppression in heart transplantation: insights from network meta-analysis of various immunosuppression regimens. Heart Fail Rev. 2022;27:869–877. PubMed

Wolf S, Hoffmann VS, Sommer F, et al. Effect of sirolimus vs. everolimus on CMV-infections after kidney transplantation—a network meta-analysis. J Clin Med. 2022;11:4216. PubMed PMC

Ye C, Li J, Liu X, et al. The incidence of cytomegalovirus and BK polyomavirus infections in kidney transplant patients receiving mTOR inhibitors: a systematic review and meta-analysis. Pharmacotherapy. 2023;43:552–562. PubMed

Jennings DL, Lange N, Shullo M, et al. Outcomes associated with mammalian target of rapamycin (mTOR) inhibitors in heart transplant recipients: a meta-analysis. Int J Cardiol. 2018;265:71–76. PubMed

Tedesco-Silva H, Felipe C, Ferreira A, et al. Reduced incidence of cytomegalovirus infection in kidney transplant recipients receiving everolimus and reduced tacrolimus doses. Am J Transplant. 2015;15:2655–2664. PubMed

Radtke J, Dietze N, Spetzler VN, et al. Fewer cytomegalovirus complications after kidney transplantation by de novo use of mTOR inhibitors in comparison to mycophenolic acid. Transpl Infect Dis. 2016;18:79–88. PubMed

Cervera C, Cofan F, Hernandez C, et al. Effect of mammalian target of rapamycin inhibitors on cytomegalovirus infection in kidney transplant recipients receiving polyclonal antilymphocyte globulins: a propensity score-matching analysis. Transpl Int. 2016;29:1216–1225. PubMed

Pascual J, Berger SP, Witzke O, et al. ; TRANSFORM Investigators. Everolimus with reduced calcineurin inhibitor exposure in renal transplantation. J Am Soc Nephrol. 2018;29:1979–1991. PubMed PMC

Maniere L, Noble J, Terrec F, et al. Cytomegalovirus disease in de novo kidney-transplant recipients: comparison of everolimus-based immunosuppression without prophylaxis with mycophenolic acid-based immunosuppression with prophylaxis. Int Urol Nephrol. 2021;53:591–600. PubMed

Kaminski H, Kamar N, Thaunat O, et al. Incidence of cytomegalovirus infection in seropositive kidney transplant recipients treated with everolimus: a randomized, open-label, multicenter phase 4 trial. Am J Transplant. 2022;22:1430–1441. PubMed

Toniato de Rezende Freschi J, Cristelli MP, Viana LA, et al. A head-to-head comparison of de novo sirolimus or everolimus plus reduced-dose tacrolimus in kidney transplant recipients: a prospective and randomized trial. Transplantation. 2024;108:261–275. PubMed

Viana LA, Cristelli MP, Basso G, et al. Conversion to mTOR inhibitor to reduce the incidence of cytomegalovirus recurrence in kidney transplant recipients receiving preemptive treatment: a prospective, randomized trial. Transplantation. 2023;107:1835–1845. PubMed

Del Bello A, Cachoux J, Abravanel F, et al. The conversion from mycophenolic acid to mammalian target of rapamycin inhibitor reduces the incidence of cytomegalovirus replication in belatacept-treated kidney-transplant recipients. Kidney Int Rep. 2024;9:1912–1915. PubMed PMC

Sheng L, Jun S, Jianfeng L, et al. The effect of sirolimus-based immunosuppression vs. conventional prophylaxis therapy on cytomegalovirus infection after liver transplantation. Clin Transplant. 2015;29:555–559. PubMed

Kobashigawa J, Ross H, Bara C, et al. Everolimus is associated with a reduced incidence of cytomegalovirus infection following de novo cardiac transplantation. Transpl Infect Dis. 2013;15:150–162. PubMed

Durante-Mangoni E, Andini R, Pinto D, et al. Effect of the immunosuppressive regimen on the incidence of cytomegalovirus infection in 378 heart transplant recipients: a single centre, prospective cohort study. J Clin Virol. 2015;68:37–42. PubMed

Turkkan S, Basaran FC, Sahin MF, et al. Everolimus use in lung transplant recipients. Transplant Proc. 2022;54:2317–2324. PubMed

Ghassemieh B, Ahya VN, Baz MA, et al. Decreased incidence of cytomegalovirus infection with sirolimus in a post hoc randomized, multicenter study in lung transplantation. J Heart Lung Transplant. 2013;32:701–706. PubMed

Ritta M, Costa C, Solidoro P, et al. Everolimus-based immunosuppressive regimens in lung transplant recipients: impact on CMV infection. Antiviral Res. 2015;113:19–26. PubMed

Strueber M, Warnecke G, Fuge J, et al. Everolimus versus mycophenolate mofetil de novo after lung transplantation: a prospective, randomized, open-label trial. Am J Transplant. 2016;16:3171–3180. PubMed

Hocker B, Zencke S, Pape L, et al. Impact of everolimus and low-dose cyclosporin on cytomegalovirus replication and disease in pediatric renal transplantation. Am J Transplant. 2016;16:921–929. PubMed

Diaz Molina B, Velasco Alonso E, Lambert Rodriguez JL, et al. Effect of early conversion to everolimus together with prophylaxis with valganciclovir in the prevention of cytomegalovirus infection in heart transplant recipients. Transplant Proc. 2015;47:130–131. PubMed

Bowman LJ, Brueckner AJ, Doligalski CT. The role of mTOR inhibitors in the management of viral infections: a review of current literature. Transplantation. 2018;102(2S Suppl 1):S50–S59. PubMed

Carbone J. The immunology of posttransplant CMV infection: potential effect of CMV immunoglobulins on distinct components of the immune response to CMV. Transplantation. 2016;100(Suppl 3):S11–S18. PubMed PMC

Kaminski H, Fishman JA. The cell biology of cytomegalovirus: implications for transplantation. Am J Transplant. 2016;16:2254–2269. PubMed

Fernandez-Ruiz M, Gimenez E, Lora D, et al. Impact of MBL2 gene polymorphisms on the risk of infection in solid organ transplant recipients: a systematic review and meta-analysis. Am J Transplant. 2019;19:1072–1085. PubMed

Fernandez-Ruiz M, Corrales I, Arias M, et al. ; OPERA Study Group. Association between individual and combined SNPs in genes related to innate immunity and incidence of CMV infection in seropositive kidney transplant recipients. Am J Transplant. 2015;15:1323–1335. PubMed

Sarmiento E, Jaramillo M, Calahorra L, et al. Evaluation of humoral immunity profiles to identify heart recipients at risk for development of severe infections: a multicenter prospective study. J Heart Lung Transplant. 2017;36:529–539. PubMed

Fernandez-Ruiz M, Silva JT, Lopez-Medrano F, et al. Post-transplant monitoring of NK cell counts as a simple approach to predict the occurrence of opportunistic infection in liver transplant recipients. Transpl Infect Dis. 2016;18:552–565. PubMed

van Duin D, Avery RK, Hemachandra S, et al. KIR and HLA interactions are associated with control of primary CMV infection in solid organ transplant recipients. Am J Transplant. 2014;14:156–162. PubMed

Gonzalez A, Schmitter K, Hirsch HH, et al. ; Swiss Transplant Cohort Study. KIR-associated protection from CMV replication requires pre-existing immunity: a prospective study in solid organ transplant recipients. Genes Immun. 2014;15:495–499. PubMed

de Rham C, Hadaya K, Bandelier C, et al. Expression of killer cell immunoglobulin-like receptors (KIRs) by natural killer cells during acute CMV infection after kidney transplantation. Transpl Immunol. 2014;31:157–164. PubMed

Knight A, Madrigal AJ, Grace S, et al. The role of Vdelta2-negative gammadelta T cells during cytomegalovirus reactivation in recipients of allogeneic stem cell transplantation. Blood. 2010;116:2164–2172. PubMed

Ravens S, Schultze-Florey C, Raha S, et al. Human gammadelta T cells are quickly reconstituted after stem-cell transplantation and show adaptive clonal expansion in response to viral infection. Nat Immunol. 2017;18:393–401. PubMed

Kaminski H, Garrigue I, Couzi L, et al. Surveillance of gammadelta T cells predicts cytomegalovirus infection resolution in kidney transplants. J Am Soc Nephrol. 2016;27:637–645. PubMed PMC

Sandonis V, Garcia-Rios E, McConnell MJ, et al. Role of neutralizing antibodies in CMV infection: implications for new therapeutic approaches. Trends Microbiol. 2020;28:900–912. PubMed

Crough T, Khanna R. Immunobiology of human cytomegalovirus: from bench to bedside. Clin Microbiol Rev. 2009;22:76–98, Table of Contents. PubMed PMC

Lilleri D, Kabanova A, Lanzavecchia A, et al. Antibodies against neutralization epitopes of human cytomegalovirus gH/gL/pUL128-130-131 complex and virus spreading may correlate with virus control in vivo. J Clin Immunol. 2012;32:1324–1331. PubMed

Fouts AE, Chan P, Stephan JP, et al. Antibodies against the gH/gL/UL128/UL130/UL131 complex comprise the majority of the anti-cytomegalovirus (anti-CMV) neutralizing antibody response in CMV hyperimmune globulin. J Virol. 2012;86:7444–7447. PubMed PMC

Genini E, Percivalle E, Sarasini A, et al. Serum antibody response to the gH/gL/pUL128-131 five-protein complex of human cytomegalovirus (HCMV) in primary and reactivated HCMV infections. J Clin Virol. 2011;52:113–118. PubMed

Filipovich AH, Peltier MH, Bechtel MK, et al. Circulating cytomegalovirus (CMV) neutralizing activity in bone marrow transplant recipients: comparison of passive immunity in a randomized study of four intravenous IgG products administered to CMV-seronegative patients. Blood. 1992;80:2656–2660. PubMed

Bonaros N, Mayer B, Schachner T, et al. CMV-hyperimmune globulin for preventing cytomegalovirus infection and disease in solid organ transplant recipients: a meta-analysis. Clin Transplant. 2008;22:89–97. PubMed

Santhanakrishnan K, Yonan N, Callan P, et al. The use of CMVIg rescue therapy in cardiothoracic transplantation: a single-center experience over 6 years (2011-2017). Clin Transplant. 2019;33:e13655. PubMed

Bourassa-Blanchette S, Knoll GA, Hutton B, et al. Clinical outcomes of polyvalent immunoglobulin use in solid organ transplant recipients: a systematic review and meta-analysis. Clin Transplant. 2019;33:e13560. PubMed

Lichvar AB, Ensor CR, Zeevi A, et al. Detrimental association of hypogammaglobulinemia with chronic lung allograft dysfunction and death is not mitigated by on-demand immunoglobulin G replacement after lung transplantation. Prog Transplant. 2018;29:18–25. PubMed

Claustre J, Quetant S, Camara B, et al. ; Grenoble Lung Transplantation Group. Nonspecific immunoglobulin replacement in lung transplantation recipients with hypogammaglobulinemia: a cohort study taking into account propensity score and immortal time bias. Transplantation. 2015;99:444–450. PubMed

Florescu DF, Kalil AC, Qiu F, et al. Does increasing immunoglobulin levels impact survival in solid organ transplant recipients with hypogammaglobulinemia? Clin Transplant. 2014;28:1249–1255. PubMed

Deng R, Wang Y, Maia M, et al. Pharmacokinetics and exposure-response analysis of RG7667, a combination of two anticytomegalovirus monoclonal antibodies, in a phase 2a randomized trial to prevent cytomegalovirus infection in high-risk kidney transplant recipients. Antimicrob Agents Chemother. 2018;62:e01108-17. PubMed PMC

Yamada A, Tashiro A, Hiraiwa T, et al. Long-term outcome of pediatric renal transplantation: a single center study in Japan. Pediatr Transplant. 2014;18:453–462. PubMed

Charlotte R, Francois P, Jonathan M, et al. Use of anti-CMV immunoglobulins in lung transplant recipients: the French experience. Transpl Infect Dis. 2021;23:e13754. PubMed

Sarmiento E, Diez P, Arraya M, et al. Early intravenous immunoglobulin replacement in hypogammaglobulinemic heart transplant recipients: results of a clinical trial. Transpl Infect Dis. 2016;18:832–843. PubMed

Yamani MH, Avery R, Mawhorter S, et al. Hypogammaglobulinemia after heart transplantation: impact of pre-emptive use of immunoglobulin replacement (CytoGam) on infection and rejection outcomes. Transpl Infect Dis. 2001;3(Suppl 2):40–43. PubMed

Ishida JH, Patel A, Mehta AK, et al. Phase 2 randomized, double-blind, placebo-controlled trial of RG7667, a combination monoclonal antibody, for prevention of cytomegalovirus infection in high-risk kidney transplant recipients. Antimicrob Agents Chemother. 2017;61:e01794-16. PubMed PMC

Hodson EM, Jones CA, Strippoli GF, et al. Immunoglobulins, vaccines or interferon for preventing cytomegalovirus disease in solid organ transplant recipients. Cochrane Database Syst Rev. 2007;2:CD005129. PubMed

ClinicalTrials.gov. A study for kidney transplant recipients at high-risk of cytomegalovirus infection. Available at https://clinicaltrials.gov/study/NCT04225923. Accessed March 25, 2025.

Kotton CN, Torre-Cisneros J, Yakoub-Agha I, et al. Slaying the “troll of transplantation”—new frontiers in cytomegalovirus management: a report from the CMV International Symposium 2023. Transpl Infect Dis. 2024;26:e14183. PubMed

Fujino T, Kumai Y, Nitta D, et al. Hypogammaglobulinemia following heart transplantation: prevalence, predictors, and clinical importance. Clin Transplant. 2020;34:e14087. PubMed

Petrov AA, Traister RS, Crespo MM, et al. A prospective observational study of hypogammaglobulinemia in the first year after lung transplantation. Transplant Direct. 2018;4:e372. PubMed PMC

Florescu DF, Kalil AC, Qiu F, et al. What is the impact of hypogammaglobulinemia on the rate of infections and survival in solid organ transplantation? A meta-analysis. Am J Transplant. 2013;13:2601–2610. PubMed

Sarmiento E, Cifrian J, Calahorra L, et al. Monitoring of early humoral immunity to identify lung recipients at risk for development of serious infections: a multicenter prospective study. J Heart Lung Transplant. 2018;37:1001–1012. PubMed

Sarmiento E, Fernandez-Yanez J, Munoz P, et al. Hypogammaglobulinemia after heart transplantation: use of intravenous immunoglobulin replacement therapy in relapsing CMV disease. Int Immunopharmacol. 2005;5:97–101. PubMed

Sarmiento E, Jimenez M, di Natale M, et al. Secondary antibody deficiency is associated with development of infection in kidney transplantation: results of a multicenter study. Transpl Infect Dis. 2021;23:e13494. PubMed

Nuevalos M, Garcia-Rios E, Mancebo FJ, et al. Novel monoclonal antibody-based therapies: implications for the treatment and prevention of HCMV disease. Trends Microbiol. 2023;31:480–497. PubMed

Dole K, Segal FP, Feire A, et al. A first-in-human study to assess the safety and pharmacokinetics of monoclonal antibodies against human cytomegalovirus in healthy volunteers. Antimicrob Agents Chemother. 2016;60:2881–2887. PubMed PMC

Okamoto M, Kurino R, Miura R, et al. A fully human neutralizing monoclonal antibody targeting a highly conserved epitope of the human cytomegalovirus glycoprotein B. PLoS One. 2023;18:e0285672. PubMed PMC

Meesing A, Razonable RR. Absolute lymphocyte count thresholds: a simple, readily available tool to predict the risk of cytomegalovirus infection after transplantation. Open Forum Infect Dis. 2018;5:ofy230. PubMed PMC

Reusing JO, Jr, Feitosa EB, Agena F, et al. Cytomegalovirus prophylaxis in seropositive renal transplant recipients receiving thymoglobulin induction therapy: outcome and risk factors for late CMV disease. Transpl Infect Dis. 2018;20:e12929. PubMed

Kwak SH, Lee SH, Park MS, et al. Risk factors for cytomegalovirus reactivation in lung transplant recipients. Lung. 2020;198:829–838. PubMed

Yoon M, Oh J, Chun KH, et al. Post-transplant absolute lymphocyte count predicts early cytomegalovirus infection after heart transplantation. Sci Rep. 2021;11:1426. PubMed PMC

Dujardin A, Lorent M, Foucher Y, et al. ; DIVAT Consortium. Time-dependent lymphocyte count after transplantation is associated with higher risk of graft failure and death. Kidney Int. 2021;99:1189–1201. PubMed

Schoeberl AK, Zuckermann A, Kaider A, et al. Absolute lymphocyte count as a marker for cytomegalovirus infection after heart transplantation. Transplantation. 2023;107:748–752. PubMed

Yetmar ZA, Kudva YC, Seville MT, et al. Risk of cytomegalovirus infection and subsequent allograft failure after pancreas transplantation. Am J Transplant. 2024;24:271–279. PubMed PMC

Nierenberg NE, Poutsiaka DD, Chow JK, et al. Pretransplant lymphopenia is a novel prognostic factor in cytomegalovirus and noncytomegalovirus invasive infections after liver transplantation. Liver Transpl. 2014;20:1497–1507. PubMed PMC

Perry WA, Paulus JK, Price LL, et al. Association between lymphopenia at 1 month posttransplant and infectious outcomes or death in heart transplant recipients. Clin Infect Dis. 2021;73:e3797–e3803. PubMed PMC

El Helou G, Lahr B, Razonable R. Absolute lymphocyte count as marker of cytomegalovirus and allograft rejection: is there a “safe corridor” after kidney transplantation? Transpl Infect Dis. 2021;23:e13489. PubMed

Shiina Y, Kawabe M, Suehiro Y, et al. Peripheral blood absolute lymphocyte count as a predictor of cytomegalovirus infection in kidney transplant recipients. Transplant Proc. 2023;55:1594–1597. PubMed

Meesing A, Abraham RS, Razonable RR. Clinical correlation of cytomegalovirus infection with CMV-specific CD8+ T-cell immune competence score and lymphocyte subsets in solid organ transplant recipients. Transplantation. 2019;103:832–838. PubMed

Fernandez-Ruiz M, Lopez-Medrano F, Allende LM, et al. Kinetics of peripheral blood lymphocyte subpopulations predicts the occurrence of opportunistic infection after kidney transplantation. Transpl Int. 2014;27:674–685. PubMed

Deborska-Materkowska D, Perkowska-Ptasinska A, Sadowska A, et al. Diagnostic utility of monitoring cytomegalovirus-specific immunity by QuantiFERON-cytomegalovirus assay in kidney transplant recipients. BMC Infect Dis. 2018;18:179. PubMed PMC

Dendle C, Mulley WR, Holdsworth S. Can immune biomarkers predict infections in solid organ transplant recipients? A review of current evidence. Transplant Rev. 2019;33:87–98. PubMed

Imlay H, Seibert AM, Hanson KE. Pathogen-agnostic immune biomarkers that predict infection after solid organ transplantation. Transpl Infect Dis. 2023;25:e14020. PubMed

Perez-Jacoiste Asin MA, Fernandez-Ruiz M, Lopez-Medrano F, et al. Monitoring of intracellular adenosine triphosphate in CD4(+) T cells to predict the occurrence of cytomegalovirus disease in kidney transplant recipients. Transpl Int. 2016;29:1094–1105. PubMed

Mian M, Natori Y, Ferreira V, et al. Evaluation of a novel global immunity assay to predict infection in organ transplant recipients. Clin Infect Dis. 2018;66:1392–1397. PubMed

Gardiner BJ, Lee SJ, Cristiano Y, et al. Evaluation of QuantiFERON PubMed

Marx S, Adam C, Mihm J, et al. A polyclonal immune function assay allows dose-dependent characterization of immunosuppressive drug effects but has limited clinical utility for predicting infection on an individual basis. Front Immunol. 2020;11:916. PubMed PMC

Mafi S, Essig M, Rerolle JP, et al. Torque teno virus viremia and QuantiFERON PubMed PMC

Redondo N, Navarro D, Aguado JM, et al. Viruses, friends, and foes: the case of Torque Teno Virus and the net state of immunosuppression. Transpl Infect Dis. 2022;24:e13778. PubMed

Blazik M, Hutchinson P, Jose MD, et al. Leukocyte phenotype and function predicts infection risk in renal transplant recipients. Nephrol Dial Transplant. 2005;20:2226–2230. PubMed

Crepin T, Gaiffe E, Courivaud C, et al. Pre-transplant end-stage renal disease-related immune risk profile in kidney transplant recipients predicts post-transplant infections. Transpl Infect Dis. 2016;18:415–422. PubMed

Dendle C, Polkinghorne KR, Mulley WR, et al. A simple score can identify kidney transplant recipients at high risk of severe infection over the following 2 years. Transpl Infect Dis. 2019;21:e13076. PubMed

Fernandez-Ruiz M, Lopez-Medrano F, Allende LM, et al. Immune risk phenotype in kidney transplant recipients: a reliable surrogate for premature immune senescence and increased susceptibility to infection? Transpl Infect Dis. 2016;18:968–970. PubMed

Fernandez-Ruiz M, Seron D, Alonso A, et al. ; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016) and Spanish Network for Research in Renal Diseases (REDinREN RD16/0009). Derivation and external validation of the SIMPLICITY score as a simple immune-based risk score to predict infection in kidney transplant recipients. Kidney Int. 2020;98:1031–1043. PubMed

Hutchinson P, Chadban SJ, Atkins RC, et al. Laboratory assessment of immune function in renal transplant patients. Nephrol Dial Transplant. 2003;18:983–989. PubMed

Perry WA, Chow JK, Nelson J, et al. A clinical model to predict the occurrence of select high-risk infections in the first year following heart transplantation. Transplant Direct. 2023;9:e1542. PubMed PMC

San-Juan R, Fernandez-Ruiz M, Ruiz-Ruigomez M, et al. ; Spanish Network for Research in Infectious Diseases (Red Española de Investigación en Patología Infecciosa [REIPI] RD16/0016). A new clinical and immunovirological score for predicting the risk of late severe infection in solid organ transplant recipients: the CLIV score. J Infect Dis. 2020;222:479–487. PubMed

Sarmiento E, del Pozo N, Gallego A, et al. Decreased levels of serum complement C3 and natural killer cells add to the predictive value of total immunoglobulin G for severe infection in heart transplant recipients. Transpl Infect Dis. 2012;14:526–539. PubMed

Sarmiento E, Navarro J, Fernandez-Yanez J, et al. Evaluation of an immunological score to assess the risk of severe infection in heart recipients. Transpl Infect Dis. 2014;16:802–812. PubMed

Bestard O, Kaminski H, Couzi L, et al. Cytomegalovirus cell-mediated immunity: ready for routine use? Transpl Int. 2023;36:11963. PubMed PMC

Sester M, Leboeuf C, Schmidt T, et al. The “ABC” of virus-specific T cell immunity in solid organ transplantation. Am J Transplant. 2016;16:1697–1706. PubMed

Manuel O, Husain S, Kumar D, et al. Assessment of cytomegalovirus-specific cell-mediated immunity for the prediction of cytomegalovirus disease in high-risk solid-organ transplant recipients: a multicenter cohort study. Clin Infect Dis. 2013;56:817–824. PubMed

Descourouez JL, Smith JA, Saddler CM, et al. Real-world experience with CMV inSIGHT T cell immunity testing in high-risk kidney and pancreas transplant recipients. Ann Pharmacother. 2024;58:796–802. PubMed

Abate D, Saldan A, Mengoli C, et al. Comparison of cytomegalovirus (CMV) enzyme-linked immunosorbent spot and CMV quantiferon gamma interferon-releasing assays in assessing risk of CMV infection in kidney transplant recipients. J Clin Microbiol. 2013;51:2501–2507. PubMed PMC

Gabanti E, Lilleri D, Scaramuzzi L, et al. Comparison of the T-cell response to human cytomegalovirus (HCMV) as detected by cytokine flow cytometry and QuantiFERON-CMV assay in HCMV-seropositive kidney transplant recipients. New Microbiol. 2018;41:195–202. PubMed

Gliga S, Fiedler M, Dornieden T, et al. Comparison of three cellular assays to predict the course of CMV infection in liver transplant recipients. Vaccines. 2021;9:88. PubMed PMC

Bestard O, Lucia M, Crespo E, et al. Pretransplant immediately early-1-specific T cell responses provide protection for CMV infection after kidney transplantation. Am J Transplant. 2013;13:1793–1805. PubMed

Cantisan S, Lara R, Montejo M, et al. Pretransplant interferon-gamma secretion by CMV-specific CD8+ T cells informs the risk of CMV replication after transplantation. Am J Transplant. 2013;13:738–745. PubMed

Paez-Vega A, Poyato A, Rodriguez-Benot A, et al. ; Spanish Network for Research in Infectious Diseases (REIPI) (RD16/0016). Analysis of spontaneous resolution of cytomegalovirus replication after transplantation in CMV-seropositive patients with pretransplant CD8+IFNG+ response. Antiviral Res. 2018;155:97–105. PubMed

Pongsakornkullachart K, Chayakulkeeree M, Vongwiwatana A, et al. QuantiFERON-Cytomegalovirus assay for prediction of cytomegalovirus viremia in kidney transplant recipients: study from high cytomegalovirus seroprevalence country. Front Cell Infect Microbiol. 2022;12:893232. PubMed PMC

Abate D, Saldan A, Fiscon M, et al. Evaluation of cytomegalovirus (CMV)-specific T cell immune reconstitution revealed that baseline antiviral immunity, prophylaxis, or preemptive therapy but not antithymocyte globulin treatment contribute to CMV-specific T cell reconstitution in kidney transplant recipients. J Infect Dis. 2010;202:585–594. PubMed

Gardiner BJ, Lee SJ, Robertson AN, et al. Real-world experience of Quantiferon-CMV directed prophylaxis in lung transplant recipients. J Heart Lung Transplant. 2022;41:1258–1267. PubMed

Weseslindtner L, Kerschner H, Steinacher D, et al. Prospective analysis of human cytomegalovirus DNAemia and specific CD8+ T cell responses in lung transplant recipients. Am J Transplant. 2012;12:2172–2180. PubMed

Kumar D, Chernenko S, Moussa G, et al. Cell-mediated immunity to predict cytomegalovirus disease in high-risk solid organ transplant recipients. Am J Transplant. 2009;9:1214–1222. PubMed

Kumar D, Chin-Hong P, Kayler L, et al. A prospective multicenter observational study of cell-mediated immunity as a predictor for cytomegalovirus infection in kidney transplant recipients. Am J Transplant. 2019;19:2505–2516. PubMed

Andreani M, Albano L, Benzaken S, et al. Monitoring of CMV-specific cell-mediated immunity in kidney transplant recipients with a high risk of CMV disease (D+/R-): a case series. Transplant Proc. 2020;52:204–211. PubMed

Lisboa LF, Kumar D, Wilson LE, et al. Clinical utility of cytomegalovirus cell-mediated immunity in transplant recipients with cytomegalovirus viremia. Transplantation. 2012;93:195–200. PubMed

Blom KB, Kro GB, Midtvedt K, et al. Cellular immunity against cytomegalovirus and risk of infection after kidney transplantation. Front Immunol. 2024;15:1414830. PubMed PMC

Jarque M, Crespo E, Melilli E, et al. Cellular immunity to predict the risk of cytomegalovirus infection in kidney transplantation: a prospective, interventional, multicenter clinical trial. Clin Infect Dis. 2020;71:2375–2385. PubMed

Paez-Vega A, Gutierrez-Gutierrez B, Aguera ML, et al. ; TIMOVAL Study Group. Immunoguided discontinuation of prophylaxis for cytomegalovirus disease in kidney transplant recipients treated with antithymocyte globulin: a randomized clinical trial. Clin Infect Dis. 2022;74:757–765. PubMed

Westall GP, Cristiano Y, Levvey BJ, et al. A randomized study of Quantiferon CMV-directed versus fixed-duration valganciclovir prophylaxis to reduce late CMV after lung transplantation. Transplantation. 2019;103:1005–1013. PubMed

Manuel O, Laager M, Hirzel C, et al. ; Swiss Transplant Cohort Study (STCS). Immune monitoring-guided versus fixed duration of antiviral prophylaxis against cytomegalovirus in solid-organ transplant recipients: a multicenter, randomized clinical trial. Clin Infect Dis. 2024;78:312–323. PubMed PMC

Fernandez-Ruiz M, Gimenez E, Vinuesa V, et al. Regular monitoring of cytomegalovirus-specific cell-mediated immunity in intermediate-risk kidney transplant recipients: predictive value of the immediate post-transplant assessment. Clin Microbiol Infect. 2019;25:381.e1–381.e10. PubMed

Solera JT, Ferreira VH, Cervera C, et al. Cell-mediated immunity to guide primary prophylaxis for CMV infection in organ transplant recipients: a multicenter single-arm prospective study. Transplantation. 2025;109:527–535. PubMed

Reusing JO, Jr, Agena F, Kotton CN, et al. QuantiFERON-CMV as a predictor of CMV events during preemptive therapy in CMV-seropositive kidney transplant recipients. Transplantation. 2024;108:985–995. PubMed

Holmes-Liew CL, Holmes M, Beagley L, et al. Adoptive T-cell immunotherapy for ganciclovir-resistant CMV disease after lung transplantation. Clin Transl Immunol. 2015;4:e35. PubMed PMC

Gupta MP, Coombs P, Prockop SE, et al. Treatment of cytomegalovirus retinitis with cytomegalovirus-specific T-lymphocyte infusion. Ophthalmic Surg Lasers Imag Retina. 2015;46:80–82. PubMed PMC

Macesic N, Langsford D, Nicholls K, et al. Adoptive T cell immunotherapy for treatment of ganciclovir-resistant cytomegalovirus disease in a renal transplant recipient. Am J Transplant. 2015;15:827–832. PubMed

Pierucci P, Malouf M, Glanville AR, et al. Novel autologous T-cell therapy for drug-resistant cytomegalovirus disease after lung transplantation. J Heart Lung Transplant. 2016;35:685–687. PubMed

Brestrich G, Zwinger S, Fischer A, et al. Adoptive T-cell therapy of a lung transplanted patient with severe CMV disease and resistance to antiviral therapy. Am J Transplant. 2009;9:1679–1684. PubMed

Smith C, Beagley L, Rehan S, et al. Autologous adoptive T-cell therapy for recurrent or drug-resistant cytomegalovirus complications in solid organ transplant recipients: a single-arm open-label phase I clinical trial. Clin Infect Dis. 2019;68:632–640. PubMed

Smith C, Corvino D, Beagley L, et al. T cell repertoire remodeling following post-transplant T cell therapy coincides with clinical response. J Clin Invest. 2019;129:5020–5032. PubMed PMC

Khoury R, Grimley MS, Nelson AS, et al. Third-party virus-specific T cells for the treatment of double-stranded DNA viral reactivation and posttransplant lymphoproliferative disease after solid organ transplant. Am J Transplant. 2024;24:1634–1643. PubMed

Prockop SE, Hasan A, Doubrovina E, et al. Third-party cytomegalovirus-specific T cells improved survival in refractory cytomegalovirus viremia after hematopoietic transplant. J Clin Invest. 2023;133:e165476. PubMed PMC

Galletta TJ, Lane A, Lutzko C, et al. Third-party and patient-specific donor-derived virus-specific T cells demonstrate similar efficacy and safety for management of viral infections after hematopoietic stem cell transplantation in children and young adults. Transplant Cell Ther. 2023;29:305–310. PubMed

Shang QN, Yu XX, Xu ZL, et al. Expanded clinical-grade NK cells exhibit stronger effects than primary NK cells against HCMV infection. Cell Mol Immunol. 2023;20:895–907. PubMed PMC

Schweitzer L, Muranski P. Virus-specific T cell therapy to treat refractory viral infections in solid organ transplant recipients. Am J Transplant. 2024;24:1558–1566. PubMed

Gerdemann U, Katari UL, Papadopoulou A, et al. Safety and clinical efficacy of rapidly-generated trivirus-directed T cells as treatment for adenovirus, EBV, and CMV infections after allogeneic hematopoietic stem cell transplant. Mol Ther. 2013;21:2113–2121. PubMed PMC

Lugthart G, Albon SJ, Ricciardelli I, et al. Simultaneous generation of multivirus-specific and regulatory T cells for adoptive immunotherapy. J Immunother. 2012;35:42–53. PubMed

Gartner BC, Sester M. Virus-specific T cell efficacy after solid organ transplantation: more questions than answers. Am J Transplant. 2024;24:1532–1533. PubMed

McVoy MA. Cytomegalovirus vaccines. Clin Infect Dis. 2013;57(Suppl 4):S196–S199. PubMed PMC

Plotkin SA, Smiley ML, Friedman HM, et al. Towne-vaccine-induced prevention of cytomegalovirus disease after renal transplants. Lancet. 1984;1:528–530. PubMed

Plotkin SA, Starr SE, Friedman HM, et al. Effect of Towne live virus vaccine on cytomegalovirus disease after renal transplant. A controlled trial. Ann Intern Med. 1991;114:525–531. PubMed

Plotkin SA, Higgins R, Kurtz JB, et al. Multicenter trial of Towne strain attenuated virus vaccine in seronegative renal transplant recipients. Transplantation. 1994;58:1176–1178. PubMed

Vincenti F, Budde K, Merville P, et al. A randomized, phase 2 study of ASP0113, a DNA-based vaccine, for the prevention of CMV in CMV-seronegative kidney transplant recipients receiving a kidney from a CMV-seropositive donor. Am J Transplant. 2018;18:2945–2954. PubMed

Mori T, Kanda Y, Takenaka K, et al. Safety of ASP0113, a cytomegalovirus DNA vaccine, in recipients undergoing allogeneic hematopoietic cell transplantation: an open-label phase 2 trial. Int J Hematol. 2017;105:206–212. PubMed

Ljungman P, Bermudez A, Logan AC, et al. A randomised, placebo-controlled phase 3 study to evaluate the efficacy and safety of ASP0113, a DNA-based CMV vaccine, in seropositive allogeneic haematopoietic cell transplant recipients. EClinMed. 2021;33:100787. PubMed PMC

Griffiths PD, Stanton A, McCarrell E, et al. Cytomegalovirus glycoprotein-B vaccine with MF59 adjuvant in transplant recipients: a phase 2 randomised placebo-controlled trial. Lancet. 2011;377:1256–1263. PubMed PMC

ClinicalTrials.gov. A study of CMV vaccine (HB-101) in kidney transplant patients. Available at https://clinicaltrials.gov/study/NCT03629080. Accessed March 21, 2025.

La Rosa C, Aldoss I, Park Y, et al. Hematopoietic stem cell donor vaccination with cytomegalovirus triplex augments frequencies of functional and durable cytomegalovirus-specific T cells in the recipient: a novel strategy to limit antiviral prophylaxis. Am J Hematol. 2023;98:588–597. PubMed PMC

Nakamura R, La Rosa C, Yang D, et al. A phase II randomized, double-blind, placebo-controlled, multicenter trial to evaluate the efficacy of Cmvpepvax for preventing CMV reactivation/disease after matched related/unrelated donor hematopoietic cell transplant. Blood. 2021;138(Suppl 1):2887–2887.

Nakamura R, La Rosa C, Longmate J, et al. Viraemia, immunogenicity, and survival outcomes of cytomegalovirus chimeric epitope vaccine supplemented with PF03512676 (CMVPepVax) in allogeneic haemopoietic stem-cell transplantation: randomised phase 1b trial. Lancet Haematol. 2016;3:e87–e98. PubMed PMC

Pass RF, Duliege AM, Boppana S, et al. A subunit cytomegalovirus vaccine based on recombinant envelope glycoprotein B and a new adjuvant. J Infect Dis. 1999;180:970–975. PubMed

Sommerer C, Schmitt A, Huckelhoven-Krauss A, et al. Peptide vaccination against cytomegalovirus induces specific T cell response in responses in CMV seronegative end-stage renal disease patients. Vaccines. 2021;9:133. PubMed PMC

Aldoss I, La Rosa C, Baden LR, et al. ; TRIPLEX VACCINE Study Group. Poxvirus vectored cytomegalovirus vaccine to prevent cytomegalovirus viremia in transplant recipients: a phase 2, randomized clinical trial. Ann Intern Med. 2020;172:306–316. PubMed PMC

ClinicalTrials.gov. Cytomegalovirus (CMV) vaccine in orthotopic liver transplant candidates (COLT). Available at https://clinicaltrials.gov/study/NCT06075745. Accessed March 21, 2025.

ClinicalTrials.gov. A study to evaluate the efficacy, safety, and immunogenicity of mRNA-1647 cytomegalovirus (CMV) vaccine in allogenic hematopoietic cell transplantation (HCT) participants. 2024. Available at https://clinicaltrials.gov/study/NCT05683457. Accessed March 21, 2025.

Avery RK, Alain S, Alexander BD, et al. ; SOLSTICE Trial Investigators. Maribavir for refractory cytomegalovirus infections with or without resistance post-transplant: results from a phase 3 randomized clinical trial. Clin Infect Dis. 2022;75:690–701. PubMed PMC

Pierce B, Richardson CL, Lacloche L, et al. Safety and efficacy of foscarnet for the management of ganciclovir-resistant or refractory cytomegalovirus infections: a single-center study. Transpl Infect Dis. 2018;20:e12852. PubMed

Kotton CN, Kamar N. New insights on CMV management in solid organ transplant patients: prevention, treatment, and management of resistant/refractory disease. Infect Dis Ther. 2023;12:333–342. PubMed PMC

Di Cristanziano V, Affeldt P, Trappe M, et al. Combined therapy with intravenous immunoglobulins, letermovir and (val-)ganciclovir in complicated courses of CMV-infection in transplant recipients. Microorgan. 2021;9:1666. PubMed PMC

Grossi PA, Kamar N, Saliba F, et al. Cytomegalovirus management in solid organ transplant recipients: a pre-COVID-19 survey from the Working Group of the European Society for Organ Transplantation. Transpl Int. 2022;35:10332. PubMed PMC

Garcia-Rios E, Nuevalos M, Mancebo FJ, et al. Is it feasible to use CMV-specific T-cell adoptive transfer as treatment against infection in SOT recipients? Front Immunol. 2021;12:657144. PubMed PMC

Anand M, Nysather J, McGraw G, et al. Viral specific T cell therapy in kidney transplant recipients—a single-center experience. Transpl Infect Dis. 2023;25:e14179. PubMed

Emery VC, Griffiths PD. Prediction of cytomegalovirus load and resistance patterns after antiviral chemotherapy. Proc Natl Acad Sci U S A. 2000;97:8039–8044. PubMed PMC

McGavin JK, Goa KL. Ganciclovir: an update of its use in the prevention of cytomegalovirus infection and disease in transplant recipients. Drugs. 2001;61:1153–1183. PubMed

Turgeon N, Hovingh GK, Fishman JA, et al. Safety and efficacy of granulocyte colony-stimulating factor in kidney and liver transplant recipients. Transpl Infect Dis. 2000;2:15–21. PubMed

Asberg A, Jardine AG, Bignamini AA, et al. ; VICTOR Study Group. Effects of the intensity of immunosuppressive therapy on outcome of treatment for CMV disease in organ transplant recipients. Am J Transplant. 2010;10:1881–1888. PubMed

Asberg A, Humar A, Rollag H, et al. Lessons learned from a randomized study of oral valganciclovir versus parenteral ganciclovir treatment of cytomegalovirus disease in solid organ transplant recipients: the VICTOR trial. Clin Infect Dis. 2016;62:1154–1160. PubMed

Razonable RR, Asberg A, Rollag H, et al. Virologic suppression measured by a cytomegalovirus (CMV) DNA test calibrated to the World Health Organization international standard is predictive of CMV disease resolution in transplant recipients. Clin Infect Dis. 2013;56:1546–1553. PubMed

Boivin G, Goyette N, Rollag H, et al. Cytomegalovirus resistance in solid organ transplant recipients treated with intravenous ganciclovir or oral valganciclovir. Antivir Ther. 2009;14:697–704. PubMed

Gardiner BJ, Chow JK, Price LL, et al. Role of secondary prophylaxis with valganciclovir in the prevention of recurrent cytomegalovirus disease in solid organ transplant recipients. Clin Infect Dis. 2017;65:2000–2007. PubMed PMC

Serrano-Alonso M, Guillen-Grima F, Martin-Moreno P, et al. Reduction in mortality associated with secondary cytomegalovirus prophylaxis after solid organ transplantation. Transpl Infect Dis. 2018;20:e12873. PubMed

Martson AG, Edwina AE, Burgerhof JGM, et al. Ganciclovir therapeutic drug monitoring in transplant recipients. J Antimicrob Chemother. 2021;76:2356–2363. PubMed PMC

Martson AG, Edwina AE, Kim HY, et al. Therapeutic drug monitoring of ganciclovir: where are we? Ther Drug Monit. 2022;44:138–147. PubMed PMC

Martson AG, Sturkenboom MGG, Knoester M, et al. ; GATEWAY-1 Study Consortium. Standard ganciclovir dosing results in slow decline of cytomegalovirus viral loads. J Antimicrob Chemother. 2022;77:466–473. PubMed PMC

Stockmann C, Roberts JK, Knackstedt ED, et al. Clinical pharmacokinetics and pharmacodynamics of ganciclovir and valganciclovir in children with cytomegalovirus infection. Expert Opin Drug Metab Toxicol. 2015;11:205–219. PubMed

Asberg A, Bjerre A, Neely M. New algorithm for valganciclovir dosing in pediatric solid organ transplant recipients. Pediatr Transplant. 2014;18:103–111. PubMed PMC

Dvorackova E, Sima M, Petrus J, et al. Ganciclovir pharmacokinetics and individualized dosing based on covariate in lung transplant recipients. Pharmaceutics. 2022;14:408. PubMed PMC

Gagermeier JP, Rusinak JD, Lurain NS, et al. Subtherapeutic ganciclovir (GCV) levels and GCV-resistant cytomegalovirus in lung transplant recipients. Transpl Infect Dis. 2014;16:941–950. PubMed

Smith JP, Weller S, Johnson B, et al. Pharmacokinetics of acyclovir and its metabolites in cerebrospinal fluid and systemic circulation after administration of high-dose valacyclovir in subjects with normal and impaired renal function. Antimicrob Agents Chemother. 2010;54:1146–1151. PubMed PMC

Perrottet N, Decosterd LA, Meylan P, et al. Valganciclovir in adult solid organ transplant recipients: pharmacokinetic and pharmacodynamic characteristics and clinical interpretation of plasma concentration measurements. Clin Pharmacokinet. 2009;48:399–418. PubMed

Padulles A, Colom H, Bestard O, et al. Contribution of population pharmacokinetics to dose optimization of ganciclovir-valganciclovir in solid-organ transplant patients. Antimicrob Agents Chemother. 2016;60:1992–2002. PubMed PMC

van der Wekken-Pas LC, Totte J, Lunel FV, et al. Therapeutic drug monitoring of ganciclovir in cytomegalovirus-infected patients with solid organ transplants and its correlation to efficacy and toxicity. Ther Drug Monit. 2023;45:533–538. PubMed PMC

Gatti M, Rinaldi M, Potena L, et al. Does therapeutic drug monitoring (TDM) of trough concentrations suffice for optimizing preemptive therapy with ganciclovir of cytomegalovirus infections in non-renal solid organ transplant recipients? Transpl Infect Dis. 2023;25:e14107. PubMed

Ritchie BM, Barreto JN, Barreto EF, et al. Relationship of ganciclovir therapeutic drug monitoring with clinical efficacy and patient safety. Antimicrob Agents Chemother. 2019;63:e01855-18. PubMed PMC

Wong DD, Ho SA, Domazetovska A, et al. Evidence supporting the use of therapeutic drug monitoring of ganciclovir in transplantation. Curr Opin Infect Dis. 2023;36:505–513. PubMed

Galar A, Valerio M, Catalan P, et al. Valganciclovir-ganciclovir use and systematic therapeutic drug monitoring: an invitation to antiviral stewardship. Antibiotics (Basel). 2021;10:77. PubMed PMC

Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16:31–41. PubMed

Inker LA, Eneanya ND, Coresh J, et al. ; Chronic Kidney Disease Epidemiology Collaboration. New creatinine- and cystatin C-based equations to estimate GFR without race. N Engl J Med. 2021;385:1737–1749. PubMed PMC

Akbari A, El Wadia H, Knoll GA, et al. Comparison of eGFR equations to guide dosing of medications for kidney transplant recipients. Transplantation. 2024;108:2270–2277. PubMed

Papanicolaou GA, Silveira FP, Langston AA, et al. Maribavir for refractory or resistant cytomegalovirus infections in hematopoietic-cell or solid-organ transplant recipients: a randomized, dose-ranging, double-blind, phase 2 study. Clin Infect Dis. 2019;68:1255–1264. PubMed PMC

Chou S, Winston DJ, Avery RK, et al. Comparative emergence of maribavir and ganciclovir resistance in a randomized phase 3 clinical trial for treatment of cytomegalovirus infection. J Infect Dis. 2025;231:e470–e477. PubMed PMC

Chavarot N, Divard G, Scemla A, et al. Increased incidence and unusual presentations of CMV disease in kidney transplant recipients after conversion to belatacept. Am J Transplant. 2021;21:2448–2458. PubMed

Lurain NS, Chou S. Antiviral drug resistance of human cytomegalovirus. Clin Microbiol Rev. 2010;23:689–712. PubMed PMC

Fisher CE, Knudsen JL, Lease ED, et al. Risk factors and outcomes of ganciclovir-resistant cytomegalovirus infection in solid organ transplant recipients. Clin Infect Dis. 2017;65:57–63. PubMed PMC

Chou S. Rapid in vitro evolution of human cytomegalovirus UL56 mutations that confer letermovir resistance. Antimicrob Agents Chemother. 2015;59:6588–6593. PubMed PMC

Boivin G, Goyette N, Farhan M, et al. Incidence of cytomegalovirus UL97 and UL54 amino acid substitutions detected after 100 or 200 days of valganciclovir prophylaxis. J Clin Virol. 2012;53:208–213. PubMed

Douglas CM, Barnard R, Holder D, et al. Letermovir resistance analysis in a clinical trial of cytomegalovirus prophylaxis for hematopoietic stem cell transplant recipients. J Infect Dis. 2020;221:1117–1126. PubMed PMC

Hantz S, Garnier-Geoffroy F, Mazeron MC, et al. ; French CMV Resistance Survey Study Group. Drug-resistant cytomegalovirus in transplant recipients: a French cohort study. J Antimicrob Chemother. 2010;65:2628–2640. PubMed

Myhre HA, Haug Dorenberg D, Kristiansen KI, et al. Incidence and outcomes of ganciclovir-resistant cytomegalovirus infections in 1244 kidney transplant recipients. Transplantation. 2011;92:217–223. PubMed

Young PG, Rubin J, Angarone M, et al. Ganciclovir-resistant cytomegalovirus infection in solid organ transplant recipients: a single-center retrospective cohort study. Transpl Infect Dis. 2016;18:390–395. PubMed

Acquier M, Taton B, Alain S, et al. Cytomegalovirus DNAemia requiring (val)ganciclovir treatment for more than 8 weeks is a key factor in the development of antiviral drug resistance. Open Forum Infect Dis. 2023;10:ofad018. PubMed PMC

Heliovaara E, Husain S, Martinu T, et al. Drug-resistant cytomegalovirus infection after lung transplantation: incidence, characteristics, and clinical outcomes. J Heart Lung Transplant. 2019;38:1268–1274. PubMed

Chou S, Alain S, Cervera C, et al. Drug resistance assessed in a phase 3 clinical trial of maribavir therapy for refractory or resistant cytomegalovirus infection in transplant recipients. J Infect Dis. 2024;229:413–421. PubMed PMC

Papanicolaou GA, Avery RK, Cordonnier C, et al. ; AURORA Trial Investigators. Treatment for first cytomegalovirus infection post-hematopoietic cell transplant in the AURORA trial: a multicenter, double-blind, randomized, phase 3 trial comparing maribavir with valganciclovir. Clin Infect Dis. 2024;78:562–572. PubMed PMC

Turner N, Strand A, Grewal DS, et al. Use of letermovir as salvage therapy for drug-resistant cytomegalovirus retinitis. Antimicrob Agents Chemother. 2019;63:e02337–e02318. PubMed PMC

Veit T, Munker D, Barton J, et al. Letermovir in lung transplant recipients with cytomegalovirus infection: a retrospective observational study. Am J Transplant. 2021;21:3449–3455. PubMed

von Hoerschelmann E, Munch J, Gao L, et al. Letermovir rescue therapy in kidney transplant recipients with refractory/resistant CMV disease. J Clin Med. 2023;13:100. PubMed PMC

Avery RK, Arav-Boger R, Marr KA, et al. Outcomes in transplant recipients treated with foscarnet for ganciclovir-resistant or refractory cytomegalovirus infection. Transplantation. 2016;100:e74–e80. PubMed PMC

Tamzali Y, Pourcher V, Azoyan L, et al. Factors associated with genotypic resistance and outcome among solid organ transplant recipients with refractory cytomegalovirus infection. Transpl Int. 2023;36:11295. PubMed PMC

Chou S, Song K, Wu J, et al. Drug resistance mutations and associated phenotypes detected in clinical trials of maribavir for treatment of cytomegalovirus infectionn. J Infect Dis. 2022;226:576–584. PubMed PMC

Sahoo MK, Lefterova MI, Yamamoto F, et al. Detection of cytomegalovirus drug resistance mutations by next-generation sequencing. J Clin Microbiol. 2013;51:3700–3710. PubMed PMC

Chou S, Boivin G, Ives J, et al. Phenotypic evaluation of previously uncharacterized cytomegalovirus DNA polymerase sequence variants detected in a valganciclovir treatment trial. J Infect Dis. 2014;209:1219–1226. PubMed PMC

Chou S. Advances in the genotypic diagnosis of cytomegalovirus antiviral drug resistance. Antiviral Res. 2020;176:104711. PubMed PMC

Hume J, Lowry K, Whiley DM, et al. Application of the ViroKey(R) SQ FLEX assay for detection of cytomegalovirus antiviral resistance. J Clin Virol. 2023;167:105556. PubMed

Mallory MA, Hymas WC, Simmon KE, et al. Development and validation of a next-generation sequencing assay with open-access analysis software for detecting resistance-associated mutations in CMV. J Clin Microbiol. 2023;61:e0082923. PubMed PMC

Streck NT, Espy MJ, Ferber MJ, et al. Use of next-generation sequencing to detect mutations associated with antiviral drug resistance in cytomegalovirus. J Clin Microbiol. 2023;61:e0042923. PubMed PMC

Hamprecht K, Eckle T, Prix L, et al. Ganciclovir-resistant cytomegalovirus disease after allogeneic stem cell transplantation: pitfalls of phenotypic diagnosis by in vitro selection of an UL97 mutant strain. J Infect Dis. 2003;187:139–143. PubMed

Liu W, Kuppermann BD, Martin DF, et al. Mutations in the cytomegalovirus UL97 gene associated with ganciclovir-resistant retinitis. J Infect Dis. 1998;177:1176–1181. PubMed

Strasfeld L, Lee I, Tatarowicz W, et al. Virologic characterization of multidrug-resistant cytomegalovirus infection in 2 transplant recipients treated with maribavir. J Infect Dis. 2010;202:104–108. PubMed

Andrei G, Van Loon E, Lerut E, et al. Persistent primary cytomegalovirus infection in a kidney transplant recipient: multi-drug resistant and compartmentalized infection leading to graft loss. Antiviral Res. 2019;168:203–209. PubMed

Kleiboeker SB. Prevalence of cytomegalovirus antiviral drug resistance in transplant recipients. Antiviral Res. 2023;215:105623. PubMed

Chou S, Satterwhite LE, Ercolani RJ. New locus of drug resistance in the human cytomegalovirus UL56 gene revealed by in vitro exposure to letermovir and ganciclovir. Antimicrob Agents Chemother. 2018;62:e00922–e00918. PubMed PMC

Chou SA. Third component of the human cytomegalovirus terminase complex is involved in letermovir resistance. Antiviral Res. 2017;148:1–4. PubMed PMC

Muller C, Tilloy V, Frobert E, et al. First clinical description of letermovir resistance mutation in cytomegalovirus UL51 gene and potential impact on the terminase complex structure. Antiviral Res. 2022;204:105361. PubMed

Chou S. Comparison of cytomegalovirus terminase gene mutations selected after exposure to three distinct inhibitor compounds. Antimicrob Agents Chemother. 2017;61:e01325–e01317. PubMed PMC

Tilloy V, Diaz-Gonzalez D, Laplace L, et al. Comprehensive Herpesviruses Antiviral drug Resistance Mutation Database (CHARMD). Antiviral Res. 2024;231:106016. PubMed

Komatsu TE, Pikis A, Naeger LK, et al. Resistance of human cytomegalovirus to ganciclovir/valganciclovir: a comprehensive review of putative resistance pathways. Antiviral Res. 2014;101:12–25. PubMed

Chou S, Watanabe J. Ganciclovir and maribavir cross-resistance revisited: relative drug susceptibilities of canonical cytomegalovirus mutants. Antiviral Res. 2024;222:105792. PubMed PMC

Piret J, Boivin G. Clinical development of letermovir and maribavir: overview of human cytomegalovirus drug resistance. Antiviral Res. 2019;163:91–105. PubMed

Chou S, Kleiboeker S. Relative frequency of cytomegalovirus UL56 gene mutations detected in genotypic letermovir resistance testing. Antiviral Res. 2022;207:105422. PubMed PMC

Chou S, Marousek GI, Van Wechel LC, et al. Growth and drug resistance phenotypes resistance mutations resulting from cytomegalovirus DNA polymerase region III mutations observed in clinical specimens. Antimicrob Agents Chemother. 2007;51:4160–4162. PubMed PMC

Lodding IP, Jorgensen M, Bennedbaek M, et al. Development and dynamics of cytomegalovirus UL97 ganciclovir in transplant recipients detected by next-generation sequencing. Open Forum Infect Dis. 2021;8:ofab462. PubMed PMC

FDA. NDA 215596: maribavir tablets. Treatment of resistant or refractory cytomegalovirus infection and disease in transplant patients. Antimicrobial Drugs Advisory Committee Meeting; 2021 October 7. Available at https://www.fda.gov/media/152833/download. Accessed March 21, 2025.

Chou S, Ercolani RJ, Derakhchan K. Antiviral activity of maribavir in combination with other drugs active against human cytomegalovirus. Antiviral Res. 2018;157:128–133. PubMed PMC

Drew WL, Liu C. Repopulation of ganciclovir-resistant cytomegalovirus by wild-type virus. Clin Transplant. 2012;26:949–952. PubMed

Linder KA, Kovacs C, Mullane KM, et al. Letermovir treatment of cytomegalovirus infection or disease in solid organ and hematopoietic cell transplant recipients. Transpl Infect Dis. 2021;23:e13687. PubMed

Robin C, Thiebaut A, Alain S, et al. Letermovir for secondary prophylaxis of cytomegalovirus infection and disease after allogeneic hematopoietic cell transplantation: results from the French compassionate program. Biol Blood Marrow Transplant. 2020;26:978–984. PubMed

Hofmann E, Sidler D, Dahdal S, et al. Emergence of letermovir resistance in solid organ transplant recipients with ganciclovir resistant cytomegalovirus infection: a case series and review of the literature. Transpl Infect Dis. 2021;23:e13515. PubMed

Santhanakrishnan K, Yonan N, Iyer K, et al. Management of ganciclovir resistance cytomegalovirus infection with CMV hyperimmune globulin and leflunomide in seven cardiothoracic transplant recipients and literature review. Transpl Infect Dis. 2022;24:e13733. PubMed

Walti CS, Khanna N, Avery RK, et al. New treatment options for refractory/resistant CMV infection. Transpl Int. 2023;36:11785. PubMed PMC

Gourin C, Alain S, Hantz S. Anti-CMV therapy, what next? A systematic review. Front Microbiol. 2023;14:1321116. PubMed PMC

Razonable RR, Humar A; AST Infectious Diseases Community of Practice. Cytomegalovirus in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):93–106. PubMed

Bowman JS, Green M, Scantlebury VP, et al. OKT3 and viral disease in pediatric liver transplant recipients. Clin Transplant. 1991;5:294–300. PubMed PMC

Iragorri S, Pillay D, Scrine M, et al. Prospective cytomegalovirus surveillance in paediatric renal transplant patients. Pediatr Nephrol. 1993;7:55–60. PubMed

Green M, Michaels MG, Katz BZ, et al. CMV-IVIG for prevention of Epstein Barr virus disease and posttransplant lymphoproliferative disease in pediatric liver transplant recipients. Am J Transplant. 2006;6:1906–1912. PubMed

Gerna G, Lilleri D, Callegaro A, et al. Prophylaxis followed by preemptive therapy versus preemptive therapy for prevention of human cytomegalovirus disease in pediatric patients undergoing liver transplantation. Transplantation. 2008;86:163–166. PubMed

Nicastro E, Giovannozzi S, Stroppa P, et al. Effectiveness of preemptive therapy for cytomegalovirus disease in pediatric liver transplantation. Transplantation. 2017;101:804–810. PubMed PMC

Madan RP, Campbell AL, Shust GF, et al. A hybrid strategy for the prevention of cytomegalovirus-related complications in pediatric liver transplantation recipients. Transplantation. 2009;87:1318–1324. PubMed

Saitoh A, Sakamoto S, Fukuda A, et al. A universal preemptive therapy for cytomegalovirus infections in children after live-donor liver transplantation. Transplantation. 2011;92:930–935. PubMed

Furuichi M, Fujiwara T, Fukuda A, et al. Fulminant hepatic failure as a risk factor for cytomegalovirus infection in children receiving preemptive therapy after living donor liver transplantation. Transplantation. 2016;100:2404–2409. PubMed

Verma A, Palaniswamy K, Cremonini G, et al. Late cytomegalovirus infection in children: high incidence of allograft rejection and hepatitis in donor negative and seropositive liver transplant recipients. Pediatr Transplant. 2017;21:e12879. PubMed

Arroyo-Orvananos J, Hernandez-Plata JA, Erro-Aboytia R, et al. Cytomegalovirus infection and disease in pediatric liver transplantation: burden of disease under a preemptive therapy approach. Pediatr Transplant. 2023;27:e14356. PubMed

Liverman R, Serluco A, Nance G, et al. Incidence of cytomegalovirus DNAemia in pediatric kidney, liver, and heart transplant recipients: efficacy and risk factors associated with failure of weight-based dosed valganciclovir prophylaxis. Pediatr Transplant. 2023;27:e14493. PubMed

Downes KJ, Sharova A, Boge CLK, et al. CMV infection and management among pediatric solid organ transplant recipients. Pediatr Transplant. 2022;26:e14220. PubMed

Das BB, Prusty BK, Niu J, et al. Cytomegalovirus infection and allograft rejection among pediatric heart transplant recipients in the era of valganciclovir prophylaxis. Pediatr Transplant. 2020;24:e13750. PubMed

Pangonis S, Paulsen G, Andersen H, et al. Evaluation of a change in cytomegalovirus prevention strategy following pediatric solid organ transplantation. Transpl Infect Dis. 2020;22:e13232. PubMed

Foca M, Demirhan S, Munoz FM, et al. Multicenter analysis of valganciclovir prophylaxis in pediatric solid organ transplant recipients. Open Forum Infect Dis. 2024;11:ofae353. PubMed PMC

Bueno J, Green M, Kocoshis S, et al. Cytomegalovirus infection after intestinal transplantation in children. Clin Infect Dis. 1997;25:1078–1083. PubMed PMC

Nayyar N, Mazariegos G, Ranganathan S, et al. Pediatric small bowel transplantation. Semin Pediatr Surg. 2010;19:68–77. PubMed

Paulsen G, Cumagun P, Mixon E, et al. Cytomegalovirus and Epstein-Barr virus infections among pediatric kidney transplant recipients at a center using universal Valganciclovir Prophylaxis. Pediatr Transplant. 2019;23:e13382. PubMed PMC

Asante-Korang A, Carapellucci J, Krasnopero D, et al. Resource utilization of cytomegalovirus immune globulin in prevention and treatment of cytomegalovirus infection in pediatric heart transplantation. Clin Transplant. 2019;33:e13750. PubMed

Pappo A, Peled O, Berkovitch M, et al. Efficacy and safety of a weight-based dosing regimen of valganciclovir for cytomegalovirus prophylaxis in pediatric solid-organ transplant recipients. Transplantation. 2019;103:1730–1735. PubMed

Ganapathi L, Blumenthal J, Alawdah L, et al. Impact of standardized protocols for cytomegalovirus disease prevention in pediatric solid organ transplant recipients. Pediatr Transplant. 2019;23:e13568. PubMed PMC

Mehta K, Al-Yabes O, Allen A, et al. Burden of cytomegalovirus DNAemia among pediatric renal transplant patients on antiviral prophylaxis: a hospital-based analysis. Pediatr Transplant. 2020;24:e13650. PubMed

Levi S, Davidovits M, Alfandari H, et al. EBV, CMV, and BK viral infections in pediatric kidney transplantation: frequency, risk factors, treatment, and outcomes. Pediatr Transplant. 2022;26:e14199. PubMed

Zang S, Zhang X, Niu J, et al. Impact of induction therapy on cytomegalovirus infection and post-transplant outcomes in pediatric heart transplant recipients receiving routine antiviral prophylaxis. Clin Transplant. 2023;37:e14836. PubMed

Danziger-Isakov LA, Worley S, Michaels MG, et al. The risk, prevention, and outcome of cytomegalovirus after pediatric lung transplantation. Transplantation. 2009;87:1541–1548. PubMed PMC

do Nascimento Ghizoni Pereira L, Tedesco-Silva H, Jr, Koch-Nogueira PC. Acute rejection in pediatric renal transplantation: retrospective study of epidemiology, risk factors, and impact on renal function. Pediatr Transplant. 2021;25:e13856. PubMed

Kranz B, Vester U, Wingen AM, et al. Acute rejection episodes in pediatric renal transplant recipients with cytomegalovirus infection. Pediatr Transplant. 2008;12:474–478. PubMed

Smith JM, Corey L, Bittner R, et al. Subclinical viremia increases risk for chronic allograft injury in pediatric renal transplantation. J Am Soc Nephrol. 2010;21:1579–1586. PubMed PMC

Hocker B, Zencke S, Krupka K, et al. Cytomegalovirus infection in pediatric renal transplantation and the impact of chemoprophylaxis with (val-)ganciclovir. Transplantation. 2016;100:862–870. PubMed

Lin A, Worley S, Brubaker J, et al. Assessment of cytomegalovirus hybrid preventative strategy in pediatric heart transplant patients. J. Pediatric Infect. Dis. Soc. 2012;1:278–283. PubMed

Mahle WT, Fourshee MT, Naftel DM, et al. ; Pediatric Heart Transplant Study Group. Does cytomegalovirus serology impact outcome after pediatric heart transplantation? J Heart Lung Transplant. 2009;28:1299–1305. PubMed

Kizilbash SJ, Rheault MN, Bangdiwala A, et al. Infection rates in tacrolimus versus cyclosporine-treated pediatric kidney transplant recipients on a rapid discontinuation of prednisone protocol: 1-year analysis. Pediatr Transplant. 2017;21:e12919. PubMed PMC

Grimm K, Lehner A, Fernandez Rodriguez S, et al. Conversion to everolimus in pediatric heart transplant recipients is a safe treatment option with an impact on cardiac allograft vasculopathy and renal function. Clin Transplant. 2021;35:e14191. PubMed

Hussain T, Burch M, Fenton MJ, et al. Positive pretransplantation cytomegalovirus serology is a risk factor for cardiac allograft vasculopathy in children. Circulation. 2007;115:1798–1805. PubMed

Rabbani N, Kronmal RA, Wagner T, et al. Association between cytomegalovirus serostatus, antiviral therapy, and allograft survival in pediatric heart transplantation. Transpl Int. 2022;35:10121. PubMed PMC

Indolfi G, Heaton N, Smith M, et al. Effect of early EBV and/or CMV viremia on graft function and acute cellular rejection in pediatric liver transplantation. Clin Transplant. 2012;26:E55–E61. PubMed

Danziger-Isakov LA, Worley S, Arrigain S, et al. Increased mortality after pulmonary fungal infection within the first year after pediatric lung transplantation. J Heart Lung Transplant. 2008;27:655–661. PubMed PMC

Liu M, Worley S, Arrigain S, et al. Respiratory viral infections within one year after pediatric lung transplant. Transpl Infect Dis. 2009;11:304–312. PubMed PMC

Ettenger R, Chin H, Kesler K, et al. Relationship among viremia/viral infection, alloimmunity, and nutritional parameters in the first year after pediatric kidney transplantation. Am J Transplant. 2017;17:1549–1562. PubMed PMC

Gotoh Y, Shishido S, Hamasaki Y, et al. Kidney function of Japanese children undergoing kidney transplant with preemptive therapy for cytomegalovirus infection. Transpl Infect Dis. 2020;22:e13271. PubMed

Oomen L, de Wall LL, Cornelissen EAM, et al. Prognostic factors on graft function in pediatric kidney recipients. Transplant Proc. 2021;53:889–896. PubMed

Krampe K, Briem-Richter A, Fischer L, et al. The value of immunoprophylaxis for cytomegalovirus infection with intravenous immunoglobulin in pediatric liver transplant recipients receiving a low-dose immunosupressive regimen. Pediatr Transplant. 2010;14:67–71. PubMed

Florescu DF, Langnas AN, Grant W, et al. Incidence, risk factors, and outcomes associated with cytomegalovirus disease in small bowel transplant recipients. Pediatr Transplant. 2012;16:294–301. PubMed

Green M, Kaufmann M, Wilson J, et al. Comparison of intravenous ganciclovir followed by oral acyclovir with intravenous ganciclovir alone for prevention of cytomegalovirus and Epstein-Barr virus disease after liver transplantation in children. Clin Infect Dis. 1997;25:1344–1349. PubMed

Bradley D, Moreira S, Subramoney V, et al. ; Valcyte NP22523 Study Team. Pharmacokinetics and safety of valganciclovir in pediatric heart transplant recipients 4 months of age and youngerr. Pediatr Infect Dis J. 2016;35:1324–1328. PubMed

Facchin A, Elie V, Benyoub N, et al. Population pharmacokinetics of ganciclovir after valganciclovir in renal transplant children. Antimicrob Agents Chemother. 2019;63:e01192-19. PubMed PMC

Franck B, Woillard JB, Theoret Y, et al. Population pharmacokinetics of ganciclovir and valganciclovir in paediatric solid organ and stem cell transplant recipients. Br J Clin Pharmacol. 2021;87:3105–3114. PubMed

Jorga K, Reigner B, Chavanne C, et al. Pediatric dosing of ganciclovir and valganciclovir: how model-based simulations can prevent underexposure and potential treatment failure. CPT Pharma Syst Pharmacol. 2019;8:167–176. PubMed PMC

Nguyen T, Oualha M, Briand C, et al. Population pharmacokinetics of intravenous ganciclovir and oral valganciclovir in a pediatric population to optimize dosing regimens. Antimicrob Agents Chemother. 2021;65:e02254-20. PubMed PMC

Peled O, Berkovitch M, Rom E, et al. Valganciclovir dosing for cytomegalovirus prophylaxis in pediatric solid-organ transplant recipients: a prospective pharmacokinetic study. Pediatr Infect Dis J. 2017;36:745–750. PubMed

Ponthier L, Autmizguine J, Franck B, et al. Optimization of ganciclovir and valganciclovir starting dose in children by machine learning. Clin Pharmacokinet. 2024;63:539–550. PubMed

Yang W, Mak W, Gwee A, et al. Establishment and evaluation of a parametric population pharmacokinetic model repository for ganciclovir and valganciclovir. Pharma. 2023;15:1801. PubMed PMC

Pescovitz MD, Ettenger RB, Strife CF, et al. Pharmacokinetics of oral valganciclovir solution and intravenous ganciclovir in pediatric renal and liver transplant recipients. Transpl Infect Dis. 2010;12:195–203. PubMed

Vaudry W, Ettenger R, Jara P, et al. ; Valcyte WV16726 Study Group. Valganciclovir dosing according to body surface area and renal function in pediatric solid organ transplant recipients. Am J Transplant. 2009;9:636–643. PubMed

Villeneuve D, Brothers A, Harvey E, et al. Valganciclovir dosing using area under the curve calculations in pediatric solid organ transplant recipients. Pediatr Transplant. 2013;17:80–85. PubMed

Schwartz GJ, Munoz A, Schneider MF, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol. 2009;20:629–637. PubMed PMC

Mian AN, Schwartz GJ. Measurement and estimation of glomerular filtration rate in children. Adv Chronic Kidney Dis. 2017;24:348–356. PubMed PMC

Varela-Fascinetto G, Benchimol C, Reyes-Acevedo R, et al. Tolerability of up to 200 days of prophylaxis with valganciclovir oral solution and/or film-coated tablets in pediatric kidney transplant recipients at risk of cytomegalovirus disease. Pediatr Transplant. 2017;21:e12833. PubMed

Demirhan S, Munoz FM, Valencia Deray KG, et al. Body surface area compared to body weight dosing of valganciclovir is associated with increased toxicity in pediatric solid organ transplantation recipients. Am J Transplant. 2023;23:1961–1971. PubMed

Arasaratnam RJ, Tzannou I, Gray T, et al. Dynamics of virus-specific T cell immunity in pediatric liver transplant recipients. Am J Transplant. 2018;18:2238–2249. PubMed PMC

Zhao W, Fakhoury M, Fila M, et al. Individualization of valganciclovir prophylaxis for cytomegalovirus infection in pediatric kidney transplant patients. Ther Drug Monit. 2012;34:326–330. PubMed

Groll AH, Schulte JH, Antmen AB, et al. Pharmacokinetics, safety, and efficacy of letermovir for cytomegalovirus prophylaxis in adolescent hematopoietic cell transplantation recipients. Pediatr Infect Dis J. 2024;43:203–208. PubMed

Product Monograph PREVYMIS™ (letermovir) Merck (USA). Prescribing Information 2017. Available at https://www.merck.com/product/usa/pi_circulars/p/prevymis/prevymis_pi.pdf. Accessed March 21, 2025.

Ranganathan K, Worley S, Michaels MG, et al. Cytomegalovirus immunoglobulin decreases the risk of cytomegalovirus infection but not disease after pediatric lung transplantation. J Heart Lung Transplant. 2009;28:1050–1056. PubMed PMC

Renoult E, Clermont MJ, Phan V, et al. Prevention of CMV disease in pediatric kidney transplant recipients: evaluation of pp67 NASBA-based pre-emptive ganciclovir therapy combined with CMV hyperimmune globulin prophylaxis in high-risk patients. Pediatr Transplant. 2008;12:420–425. PubMed

Snydman DR, Kistler KD, Ulsh P, et al. Cytomegalovirus prevention and long-term recipient and graft survival in pediatric heart transplant recipients. Transplantation. 2010;90:1432–1438. PubMed

Snydman DR, Kistler KD, Ulsh P, et al. The impact of CMV prevention on long-term recipient and graft survival in heart transplant recipients: analysis of the Scientific Registry of Transplant Recipients (SRTR) database. Clin Transplant. 2011;25:E455–E462. PubMed

Getsuwan S, Apiwattanakul N, Lertudomphonwanit C, et al. Cytomegalovirus-specific T cells in pediatric liver transplant recipients. Viruses. 2023;15:2213. PubMed PMC

Jacobsen MC, Manunta MDI, Pincott ES, et al. Specific immunity to cytomegalovirus in pediatric cardiac transplantation. Transplantation. 2018;102:1569–1575. PubMed

Sun K, Hayes S, Farrell C, et al. Population pharmacokinetic modeling and simulation of maribavir to support dose selection and regulatory approval in adolescents with posttransplant refractory cytomegalovirus. CPT Pharma Syst Pharmacol. 2023;12:719–723. PubMed PMC

Bruminhent J, Rotjanapan P, Watcharananan SP. Epidemiology and outcome of ganciclovir-resistant cytomegalovirus infection after solid organ transplantation: a single transplant center experience in Thailand. Transplant Proc. 2017;49:1048–1052. PubMed

Yasri S, Wiwanitkit V. Probability of ganciclovir resistance in cytomegalovirus-infected pediatric kidney transplant recipients after cessation of standard antiviral prophylaxis: estimated risk on Thai cases. Saudi J Kidney Dis Transpl. 2019;30:1000–1001. PubMed

Gilbert C, Boivin G. Human cytomegalovirus resistance to antiviral drugs. Antimicrob Agents Chemother. 2005;49:873–883. PubMed PMC

Kim YJ, Boeckh M, Cook L, et al. Cytomegalovirus infection and ganciclovir resistance caused by UL97 mutations in pediatric transplant recipients. Transpl Infect Dis. 2012;14:611–617. PubMed

Martin M, Goyette N, Ives J, et al. Incidence and characterization of cytomegalovirus resistance mutations among pediatric solid organ transplant patients who received valganciclovir prophylaxis. J Clin Virol. 2010;47:321–324. PubMed

Balfour HH, Jr. Cytomegalovirus: the troll of transplantation. Arch Intern Med. 1979;139:279–280. PubMed