Pharmacotherapy of post-transplant viral infections.

BACKGROUND Management of a number of significant viral pathogens in transplant recipients remains challenging. OBJECTIVES To define an optimal antiviral approach to the management of cytomegalovirus (CMV), human herpes virus-6 (HHV-6), Epstein-Barr (EBV)-associated post-transplant lymphoproliferative disorder (PTLD), and polyoma virus-associated nephropathy in transplant recipients. METHODS Clinical trials and existing data regarding use of antiviral agents for these viruses were reviewed to develop evidence-based recommendations for their management. CONCLUSIONS Weighing the current evidence regarding the use of valganciclovir as pre-emptive therapy or prophylaxis, the former approach offers a greater benefit for the overall prevention of CMV disease. Limited data show that prophylaxis with antiviral agents is associated with a reduction in the risk of EBV-associated PTLD. Treatment options for HHV-6 and polyoma virus-associated nephropathy are still limited.