Cytomegalovirus in Solid Organ Transplant Recipients: An Integrative Review of Diagnosis, Prophylaxis, and Clinical Impact

Abstract

Introduction: Cytomegalovirus (CMV) infection remains one of the leading infectious complications in patients undergoing solid organ transplantation. It is associated with increased morbidity and mortality, prolonged hospitalization, acute graft rejection, and a higher risk of opportunistic infections. The development of CMV disease is directly related to the degree of immunosuppression, the donor and recipient serological status, and the absence or failure of prophylactic strategies. Despite advances in antiviral prophylaxis and molecular monitoring, CMV infection continues to represent a major challenge in post-transplant care, requiring early diagnosis and timely treatment to preserve graft function and improve clinical outcomes.

Objective: To analyze the available evidence on cytomegalovirus infection in solid organ transplant recipients, emphasizing risk factors, diagnostic methods, prevention strategies, and clinical impact.

Methodology: This integrative literature review was conducted using the PubMed, Scopus, and Virtual Health Library (VHL) databases. The descriptors "Cytomegalovirus," "Solid Organ Transplantation," "Antiviral Prophylaxis," and "Immunosuppression" were combined using the Boolean operators AND and OR. Articles published between 2020 and 2026, available in full text in English, Portuguese, and Spanish, were included. Editorials, letters to the editor, case reports, and studies not directly related to solid organ transplantation were excluded.

Results: The reviewed studies demonstrated that CMV infection remains one of the most frequent infectious complications following solid organ transplantation, particularly among seronegative recipients receiving organs from seropositive donors (D+/R−), who are considered at the highest risk. Valganciclovir prophylaxis significantly reduced the incidence of CMV disease, although late-onset cases were observed after discontinuation of prophylaxis. Quantitative polymerase chain reaction (PCR) monitoring enabled early diagnosis and prompt initiation of treatment, reducing severe complications. In addition to its direct pathogenic effects, CMV infection was associated with increased rates of acute graft rejection, secondary bacterial and fungal infections, chronic graft dysfunction, and higher mortality. Individualized strategies based on risk stratification and virological surveillance were associated with improved clinical outcomes.

Conclusions: Cytomegalovirus infection remains a significant cause of morbidity after solid organ transplantation. Early identification of high-risk patients, combined with appropriate antiviral prophylaxis and periodic molecular monitoring, is essential to reduce complications, preserve graft function, and improve survival among transplant recipients.