Preventing congenital cytomegalovirus infection in transplant recipients; a focus on uterine transplantation.

Uterine transplantation (UTx) offers the only treatment for those with uterine factor infertility to carry their own pregnancy. Cytomegalovirus infection is significant in UTx, given its implications for both transplant and pregnancy. There is little evidence and no management guidance on cytomegalovirus in periconception and pregnancy in transplant recipients and no consensus or guidelines on managing cytomegalovirus in UTx. This review highlights the pertinent issues surrounding cytomegalovirus infection following transplantation and congenital cytomegalovirus infection. It summarises the published cases of periconceptional/antenatal cytomegalovirus infection in transplant recipients, outlines the UK UTx team's experience and draws on expert opinion to propose a management strategy for the prevention of congenial cytomegalovirus infection following UTx, which is also applicable to other transplants. The highest risk group for infection are cytomegalovirus IgG negative recipients receiving IgG positive organs (D+/R-). 11 cases of periconceptional/antenatal cytomegalovirus infection have been described, including one UTx case. This team proposes six months of prophylaxis for D+/R-transplant recipients post-transplant. Maternal cytomegalovirus DNA viral load should be checked shortly prior to embryo transfer (ET) in all patients. Prophylaxis (valaciclovir or cytomegalovirus-hyperimmune globulin) around ET and may be considered in D+/R-recipients who have not contracted cytomegalovirus. Frequent monitoring for infection is required in pregnancy. Valaciclovir or cytomegalovirus-hyperimmune globulin should be used to treat infection prior to 20 weeks' gestation due to teratogenicity risk associated with valganciclovir. Valganciclovir may be considered in severe infection and after 20 weeks'. A worldwide registry on cytomegalovirus infection in pregnancy would be useful for future research.