CMV Management in Transplantation

The management of cytomegalovirus (CMV) in transplant medicine is undergoing a remarkable modernization, reflecting years of progress in research and clinical practice. Once dubbed the “troll of transplantation” for its persistent and multifaceted impact, CMV remains one of the most common and consequential opportunistic infections in solid organ transplant recipients, capable of causing direct illness and influencing long-term allograft outcomes through immunomodulatory effects. Years of foundational research, translational science, and rigorous clinical trials have culminated in a more scientific and evidence-based approach to CMV prevention, diagnosis, and treatment.

Fourth International Consensus Guidelines, A Shift Toward Immune-Guided Care

This evolution is reflected in the newly released Fourth International Consensus Guidelines on CMV Management, developed by a global panel of experts supported by The Transplantation Society. The guidelines emphasize a more nuanced approach and provides a comprehensive look at best practices related to CMV management after organ transplantation. Some key points that are highlighted within the abstract:

• CMV-QNAT testing aligned with WHO standards
• Letermovir prophylaxis for D+/R– kidney transplant recipients.
• Immunologic testing to guide prophylaxis in R+ kidney transplant patients.
• Updated recommendations for valganciclovir, ganciclovir, and maribavir.
• Pediatric-specific strategies and calls for novel drug development.

The Fourth International Consensus Guidelines represent a pivotal advancement in the global effort to improve CMV management in solid organ transplantation. By integrating the latest evidence and expert consensus, the guidelines emphasize a more individualized approach—balancing virologic monitoring with immune profiling, refining prophylaxis strategies, and addressing the unique needs of pediatric and high-risk populations.

World Transplant Congress (WTC) 2025, Expert-Led CMV Education

At WTC 2025 in San Francisco, CMV was a central theme in CME-accredited sessions led by respected transplant infectious disease leaders. Key topics addressed and discussed included:

• Case-based strategies for managing refractory CMV.
• Approaches to minimize CMV risk in high-risk kidney transplant recipients.
• Emphasis on multi-modal diagnostics to personalize care.

With CMV linked to graft rejection, opportunistic infections, and reduced survival, a critical opportunity exists to make an impact. Eurofins Viracor’s CMV diagnostics encourage and empower clinicians to stratify risk more accurately, aid in the optimization of prophylaxis and therapy, and help improve patient and graft outcomes.

Eurofins Viracor’s CMV Testing for Transplant & Immunocompromised Patients

The CMV inSIGHT™ T Cell Immunity Panel assay quantifies CD4+ and CD8+ T cell responses to CMV-specific antigens using intracellular cytokine staining and flow cytometry. This assay helps clinicians assess CMV-specific immune response, predict risk of CMV reactivation or disease, and tailor prophylaxis and preemptive therapy. In line with the 2025 guidelines, CMV inSIGHT™ supports immune-guided decision-making, especially in R+ kidney transplant recipients where prophylaxis strategies are evolving.

Quantitative CMV PCR can be used for early detection and reactivation, primary infection and monitoring response to treatment. Dual gene targets and multiple probes increases the assay’s ability to pick up polymorphisms therefore reducing the chance for false negatives and detecting other strains that could be missed.

Additionally, patient outcomes depend on effective prophylaxis and treatment with antiviral therapies included ganciclovir, valganciclovir, foscarnet, cidofovir, letermovir, and maribavir. Laboratory testing should be used to confirm drug resistance, as treatment modification based solely on clinical suspicion may result in added toxicity and increased complexity in patient management.

Explore our CMV testing portfolio and learn how it aligns with the latest clinical guidelines at Eurofins Viracor.

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