A call for cytomegalovirus stewardship initiatives in cardiothoracic transplant
Hanna L. Kleiboeker, PharmD, BCTXP,
Jillian L. Descourouez,
Emily M. Garcia,
Olivia G. Huber,
Ravi Dhingra,
Erin Lowery,
Didier A. Mandelbrot, MD,
Jeannina A. Smith,
Christopher M. Saddler,
Margaret R. Jorgenson
Affiliations
Hanna L. Kleiboeker, PharmD, BCTXP
Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois; Corresponding author. Hanna L. Kleiboeker, PharmD, BCTXP, Clinical Pharmacist, Northwestern Memorial Hospital, Chicago, IL.
Jillian L. Descourouez
Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
Emily M. Garcia
Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
Olivia G. Huber
Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
Ravi Dhingra
Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Erin Lowery
Department of Medicine, Division of Pulmonary Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Didier A. Mandelbrot, MD
Department of Medicine, Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Jeannina A. Smith
Department of Medicine, Division of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Christopher M. Saddler
Department of Medicine, Division of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Margaret R. Jorgenson
Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
Despite the availability of potent antiviral therapy and increasingly long prophylaxis courses, cytomegalovirus (CMV) infection continues to negatively affect outcomes after cardiothoracic transplant (CT). CMV antiviral stewardship (AVS) represents an opportunity to implement organ-specific prophylaxis, treatment, and monitoring algorithms while optimizing care of the allograft and patient. Within the nuanced context of heart and lung transplant recipients, CMV prophylaxis, monitoring, and treatment strategies are reviewed for efficacy and safety. These insights highlight opportunities for CMV AVS programs to combine organ- and patient-specific data while implementing CMV guidelines, appropriately adopted to local context by local experts, with concurrent and retrospective evaluation for each patient and the transplant program. By applying concepts of CMV AVS currently practiced in abdominal transplant, CT programs can work to improve graft and patient outcomes related to CMV, including ongoing challenges such as atherosclerosis and impaired endothelial function in heart transplant recipients and chronic lung allograft dysfunction in lung transplant recipients. While implementation of CMV AVS is not without challenges, it also represents an opportunity for multidisciplinary teams to foster the development of CMV-specific cell-mediated immunity and improve long-term outcomes.
