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).