CMV Serostatus Mismatch — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

EasyImmunocompromised HostCMV Serostatus MismatchSCE Infectious Diseases

A 48-year-old man receives a solid organ transplant. His pre-transplant CMV serostatus was negative (R-), and the donor was CMV-positive (D+). This D+/R- combination represents the highest risk for what complication?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Primary CMV disease in the recipient (highest risk serostatus mismatch for CMV disease post-transplant)

D+/R- (donor positive, recipient negative) is the highest-risk CMV serostatus combination for post-transplant CMV disease. The seronegative recipient lacks pre-existing CMV immunity and receives a graft harbouring latent CMV. Without prophylaxis, CMV disease develops in >50% of D+/R- SOT recipients. Management options include universal prophylaxis (Valganciclovir for 3–6 months post-transplant) or pre-emptive monitoring (weekly CMV PCR with treatment if viraemia rises). D+/R- patients receive the longest prophylaxis courses.

Reference: NICE NG37 2016 – SOT: CMV prevention; ECIL-7 2019 – CMV in transplant