To The Editors:

We have clearly shown in our data that a wait-and-watch strategy is very effective when the cytomegalovirus (CMV) DNA count is positive but <500 copies/mL.1 In patients with a CMV DNA count ≥500 copies/mL, we are advocating that treatment be considered if these patients are getting high-dose steroids for rejection. We do not use induction antibodies, but if these are being used, by the same analogy, that becomes an indication for treatment if the DNA count is >500 copies/mL. Moreover, late-onset CMV disease, which is a significant problem in patients receiving treatment for CMV, was not seen in our patient group. This further makes the wait-and-watch strategy more exciting than universal prophylaxis or preemptive therapy.

Only a small percentage of seropositive recipients will develop CMV disease. Using this strategy, we did not lose any patients in our series because of CMV disease. In a similar series by Müller etal.,2 only 12% of seropositive patients developed disease. The survival curves were similar for CMV-infected patients and uninfected patients in our series1 as well as the series published by Müller etal.


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  • 1
    Wadhawan M, Gupta S, Goyal N, Vasudevan KR, Makki K, Dawar R, etal. Cytomegalovirus infection: its incidence and management in cytomegalovirus-seropositive living related liver transplant recipients: a single-center experience. Liver Transpl 2012; 18: 14481455.
  • 2
    Müller V, Perrakis A, Meyer J, Förtsch T, Korn K, Croner RS, etal. The value of pre-emptive therapy for cytomegalovirus after liver transplantation. Transplant Proc 2012; 44: 13571361.

Manav Wadhawan M.D*, Subash Gupta M.S†, * Department of Hepatology and Liver Transplantation, Indraprastha Apollo Hospital, New Delhi, India, † Department of Surgical Gastroenterology and Liver Transplantation, Indraprastha Apollo Hospital, New Delhi, India.