CMV stands for cytomegalovirus. Most of the population has been exposed to it and will rarely cause any problem to healthy persons. But it could cause a lot of trouble for patients who have had an organ transplant. CMV is from the family of herpes virus such as chickenpox, infectious mononucleosis and fever blisters (herpes I) and most people have been infected by the time they reach adulthood. The virus will remain dormant for years and sometime can flare up with minimal or no symptoms.
CMV and Organ Transplant
For organ transplant patients, the CMV virus is a problem because of the weakened immune system. Worst case scenarios of this infection could cause complications that could be fatal. Most transplant candidates have already been infected in their lives without even knowing about it. The rare ones who have never been exposed will most likely get it from the donor. Very few lucky recipients with no prior exposure to the virus will get an organ from someone not exposed as well. Those cases represent less than 10% of all organ transplants but could potentially receive it by a blood transfusion. For those transplant recipients who are CMV negative but receive a CMV positive organ it is called a mismatch. Extra precautions need to be taken to avoid complications. The recipient will be exposed to CMV in an immune compromised state. The transplant community feels there are more benefits to transplant a CMV positive organ to a non-positive patient than risk because organs are so rare. Organ transplant candidates have a lot more chance dying while waiting for an organ than dying from CMV itself. Major complications from CMV remains rare. This is why it is done on a daily basis in the country.
An active CMV infection is hard to diagnose without the blood test. The symptoms, not always obvious, are very similar to anything that a transplanted patient can experience every once in a while. It could be fever, extreme fatigue and general ill feeling. The only way to know for sure if there is a CMV infection is by doing blood test or sending specimen from intestine or lungs to the labs.
CMV infection can’t be treated with antibiotics because it is a virus. An antiviral drug is needed. The drug of choice is Valcyte or Valgancyclovir who prevents viral cells from multiplying in your body. It will not cure CMV but will control it. The major problem is the cost. It is very expensive with a price tag of at least $2,500 a month without insurance. Fortunately an assistance program is offered for qualified patients by Genentech who is the maker of Valcyte. It is also good to know that most immediate organ transplant patients are sent home with Valgancyclovir if they have been exposed to the virus one way or another. So, don’t be surprise if you have it on your discharge medications list! The reason behind the mass prescription of this drug is that CMV infection is an easily avoidable major complication of transplantation. If patients show no sign of CMV complication 6-12 months post transplant, the drug is usually stopped. Routine blood tests need to be done on a regular basis to monitor the virus.