Article information
Resumen
A pesar de la mejora en las estrategias de prevención, el citomegalovirus (CMV) continúa siendo el principal causante de infección en los pacientes trasplantados de órgano sólido. En estos pacientes, además de efectos directos, como el síndrome viral o la enfermedad invasiva de órgano, el CMV puede ocasionar efectos indirectos que resultan de la interacción del virus con el sistema inmune del huésped. Esta interacción puede desembocar en un mayor grado de inmunosupresión, con el consiguiente aumento de infecciones oportunistas, en un mayor riesgo de malignidad (enfermedad linfoproliferativa postrasplante asociada al virus de Epstein-Barr) y en un mayor riesgo de disfunción del injerto. Aunque en la actualidad no puede establecerse una relación directa de causalidad entre el CMV y la mayoría de los efectos indirectos descritos, numerosos estudios experimentales y clínicos han evidenciado una asociación entre la aparición de estos efectos y el CMV. Además, se ha evidenciado la disminución del riesgo de alguno de estos efectos, como la aparición de infecciones oportunistas, con la instauración de pautas de profilaxis frente al virus.
Palabras clave:
Citomegalovirus
Efectos indirectos
Rechazo
Trasplante
Inmunosupresión
Infección
Abstract
Despite improvements in prevention strategies, cytomegalovirus (CMV) continues to be the main cause of infection in solid organ transplant recipients. In these patients, in addition to direct effects, such as viral syndrome or invasive organ disease, CMV can cause indirect effects resulting from the interaction of the virus with the host's immune system. This interaction may increase immunosuppression, with a consequent rise in opportunistic infections and the risk of malignancies (Epstein-Barr virus-associated posttransplantation lymphoproliferative disease) and graft dysfunction. Currently, a direct causal relation between CMV and most of the indirect effects described cannot be established. However, numerous experimental and clinical studies have found an association between the development of these effects and CMV. Moreover, some of these effects, such as the development of opportunistic infections, have been reduced by CMV prophylaxis.
Keywords:
Cytomegalovirus
Indirect effects
Rejection
Transplant
Immunosuppression
Infection
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