Indirect effects of CMV in the solid organ transplant patient.

Recent research has led to the identification of risk factors for cytomegalovirus (CMV) infection and disease in the solid organ transplant patient, leading to increasingly effective prophylactic regimens. These strategies have led to a decreased incidence of CMV infection and disease and a decrease in what has become known as the "direct" effects of CMV. Accumulating evidence, however, suggests that there are several "indirect" effects of CMV infection, which significantly impact management and outcome of transplant recipients. Some of the postulated indirect effects of CMV infection in this population include various opportunistic infections and graft rejection, as well as the attendant increased cost and resource utilization by transplant programs. An evaluation of such indirect effects may allow us to improve our care of the transplant population while reducing cost and resource use.