*2.5.1.3 Prophylaxis in D−/R−*

*Perioperative Care for Organ Transplant Recipient*

base and the edge of ulcers [28, 31].

**2.5 Prevention of CMV disease**

*2.5.1 CMV prophylaxis therapy*

group of KTRs at most risk (D+/R−) [36, 37].

deficiency in the transplant recipient.

*2.5.1.1 Prophylaxis in D+/R− recipient*

*2.5.1.2 Prophylaxis in D+/R+ or D−/R+*

following transplantation.

morphology, and the number of viral copies by qPCR in IBD patients. Both immunohistochemistry and qPCR can therefore be successfully used for diagnosing CMV reactivation, at least in CMV reactivation in patients with IBD. The optimal sites for endoscopic biopsies to obtain specimens with the highest values of CMV are the

CMV can be prevented in two ways: by prophylaxis and by preemptive treat-

CMV prophylaxis is widely used in the transplantation setting and has been associated with reductions in CMV disease, mortality, and graft rejection. Prophylaxis refers to the administration of antiviral drugs to all patients (universal prophylaxis) or to a subgroup of patients at higher risk of viral replication (specific prophylaxis) for a predetermined period of time. In KTRs, prophylaxis therapy aims to prevent CMV infection and, consequently, CMV-associated disease. According to current guidelines, universal prophylaxis is recommended in patients with high risk (i.e., those who have D+/R− CMV IgG or who have received T-cell depletion for induction prior to transplantation). Antiviral drug treatment should begin immediately after transplantation or after the use of antilymphocyte antibodies. Patients with low to intermediate risk can undergo preemptive treatment instead of prophylaxis [35]. Until recently, the emphasis on prophylaxis with prophylactic agents focused on early disease occurring in high-risk patients, with the duration of prophylaxis typically no longer than 3 months. Although early-onset CMV infection was usually sufficiently controlled, the reported incidence of delayed-onset CMV infection following the completion of a 3-month course of preventive therapy was high, and, consequently, prophylactic therapy in most centers was extended to 6 months in the

Several medications are available: acyclovir, valacyclovir, intravenous ganciclovir, oral ganciclovir, and valganciclovir. Ganciclovir takes precedence over acyclovir. In a clinical setting, the most commonly used medication for prophylaxis is oral

The prophylaxis should be initiated immediately after transplantation. The decision on the duration of prophylaxis depends on the CMV serostatus of the donor (D) and recipient (R), of the organ transplant, and the degree of immune

In D+/R−, prophylaxis should last for 3–6 months. According to recent research, many transplant centers are opting for a 6-month prophylaxis, which has been associated with a significant decrease in the incidence of late CMV disease, compared to 3-month prophylaxis. Valganciclovir at a dosage of 900 mg orally once daily with the dose adjusted for renal function is used in most centers for a period of 6 months

In D+/R+ or D−/R+, prophylaxis should last for 3 months. Extension to 6 months is suggested for KTRs who have received antilymphocyte antibody

valganciclovir with dose adjustment according to kidney function [38].

ment. Both options are effective for preventing CMV disease [32–34].

**44**

There is little risk of CMV infection in these patients. Precautions for transfusion of blood and blood products of CMV-positive donors are required [35].
