Introduction
Cytomegalovirus (CMV) is one of the herpes viruses known to spread widely; the incidence rate ranges between 60-100% in adulthood (1), CMV is also one of the most prominent viruses that cause infection as a complication of kidney transplantation (1). The donor-recipient (D/R) serostatus is highly responsible for the incidence of CMV infection, with the (R+) constellation bearing the highest risk, followed by (D-/R-), and (D+/R-) (2). CMV infections can be classified into three broad headings: Regarding incidence: autoactivation of latent CMV infection in the recipient, transmitted from the donor by the allograft, or a recent infection acquired from the surrounding environment (1). Clinical presentation includes asymptomatic infection and CMV disease, which is categorized into two main subtypes: CMV viral syndrome and CMV invasive tissue disease.
CMV Viral Syndrome, This subtype presents with various symptoms such as fever, malaise, cervical lymphadenitis, arthralgia, and a reduction in white blood cell count (1, 2, 3). CMV, Invasive Tissue Disease, This subtype manifests as injury and dysfunction in vital organs, commonly involving the liver (hepatitis), gastrointestinal tract (gastroenteritis), and lungs (pneumonitis). In rare instances, it may also affect other organs like the colon (colitis), retina (retinitis), kidneys (nephritis), brain (encephalitis), and pancreas (pancreatitis) (1, 4). The infection usually happens early (within the first 6 months) after transplantation, whereas late cytomegalovirus infection (LCI) is relatively uncommon, with a reported prevalence as low as 4% (5). To diagnose an effective CMV infection, one of two methods can be followed, either the pp65 antigenemia assay or polymerase chain reaction (preferred for early detection and monitoring of viral load after transplantation) (6). Recent studies have shown equal efficacy of intravenous ganciclovir and oral valganciclovir in the treatment of CMV infection, with two ways to apply it: pre-emptive therapy and antiviral prophylaxis (1). It should be noted that antiviral therapy is only licensed for immunocompromised patients (7).
We must take ganciclovir resistance into account when the viral load remains stable or begins to increase with increasing severity of symptoms despite treatment.
Finally, CMV infection showed an increase in the morbidity and mortality of patients, in addition to some indirect complications, including graft dysfunction, coronary atherosclerosis, and opportunistic infections (6). in addition to life-threatening complications associated with hypercoagulability and Deep Vein Thrombosis (DVT), such as pulmonary embolism (7).