33: Troll of Transplantation Part 1

This podcast episode on infectious diseases focuses on Cytomegalovirus (CMV) in solid organ transplant recipients, particularly renal transplants. Dr. Joseph Sassine, a transplant ID physician, explains the differences between antiviral prophylaxis and preemptive therapy for CMV prevention, emphasizing the importance of donor and recipient serostatus in risk stratification. The discussion covers CMV's direct lytic and indirect immunomodulatory effects, including associations with graft rejection and increased susceptibility to other infections. The hosts and Dr. Sassine explore the differential diagnosis of diarrhea in transplant patients, including bacterial, viral, and parasitic infections, as well as non-infectious causes like immunosuppressive medications. The episode further delves into CMV treatment regimens, distinguishing between induction and maintenance therapy, and highlights new therapies like Maribavir.