# Cytomegalovirus infections in thoracic organ transplant recipients: Updates on prevention, treatment, and immune monitoring

## TL;DR

This review discusses how to better prevent and treat cytomegalovirus infections in people who have received thoracic organ transplants.

## Contribution

The paper provides updated insights and identifies research gaps specific to cytomegalovirus management in thoracic organ transplant recipients.

## Key findings

- Current CMV management strategies in thoracic organ transplant recipients are extrapolated from other transplant populations.
- Late-onset CMV infection and antiviral resistance remain significant challenges in this group.
- CMV cell-mediated immune monitoring and novel antivirals show potential for improved outcomes.

## Abstract

Cytomegalovirus (CMV) is a major cause of morbidity following solid organ transplantation, with thoracic organ transplant recipients (TOTRs) representing one of the highest risk groups. Despite this elevated risk, TOTRs are under-represented in clinical research, and current management strategies are largely extrapolated from other transplant populations.

This review synthesizes evidence on CMV epidemiology, clinical outcomes, prevention, and treatment in TOTRs.

Despite the success of antiviral prophylaxis and pre-emptive monitoring strategies in reducing CMV-related complications in this population, late-onset infection and antiviral resistance remain major clinical challenges. We explore the potential role of CMV in chronic rejection, evaluate the utility of CMV cell-mediated immune monitoring, and review the clinical experience with novel antivirals in TOTRs. By identifying key evidence gaps and outlining priorities for future research, this review aims to support the development of targeted and more effective CMV management strategies in this high-risk population.