Epidemiology and clinical management of cytomegalovirus infection in transplant recipients in Central and Eastern Europe - a physician survey.

BackgroundPosttransplant cytomegalovirus (PT-CMV) infection remains a challenging complication and a major cause of morbidity and mortality in transplant recipients.MethodsThis cross-sectional study surveyed physicians treating solid organ and hematopoietic stem cell transplantation recipients from Central and Eastern European countries. Physician-reported CMV infection prevalence in transplant recipients, treatment regimens, and unmet needs for managing patients with refractory with/without resistance (R+/R-) PT-CMV infection were assessed.ResultsOverall, 164 physicians completed the survey, 23.8% of whom were nephrologists. Physicians estimated that 26.4% of patients who received a transplant in the past 12 months developed PT-CMV infection, of whom 12.9% had refractory R+/R- PT-CMV infection. On average, 66.5%, 16.5%, and 4.0% of physicians' current patients with PT-CMV infection received first-, second-, and third- or later-line treatments, respectively. Physicians considered maintenance of CMV viremia clearance (94.5%), good symptom control (94.5%), and lack of renal toxicity (93.9%) as moderately-to-extremely important treatment attributes for managing PT-CMV infection. Compared with other available treatments, more physicians indicated oral valganciclovir to have a strong-to-complete association with these treatment attributes. Overall, 63.4% of physicians indicated some level of satisfaction with conventional refractory R+/R- PT-CMV treatments. However, 54.9% of physicians reported limited experience with newly approved therapies, such as maribavir. Most physicians considered limited treatment options as a major barrier for improving patient outcomes.ConclusionSurvey findings of physicians treating transplant recipients in Central and Eastern Europe suggest the need for increased awareness of newly approved therapies with better efficacy and less toxicity for refractory R+/R- PT-CMV infection.