Article information
Resumen
Los receptores de un trasplante de pulmón tienen un riesgo incrementado de infección o enfermedad por citomegalovirus (CMV). Al prevenir este acontecimiento podemos evitar los efectos indirectos relacionados, como son las infecciones fúngicas invasivas y la bronquiolitis obliterante, siendo esta última uno de los factores limitantes de la supervivencia de los pacientes. Las estrategias de prevención han conllevado una importante disminución en la incidencia de la enfermedad por CMV y de su mortalidad relacionada. Las dos principales estrategias para la prevención de la enfermedad por CMV son la profilaxis universal y la terapia anticipada. En el trasplante pulmonar, la eficacia y seguridad del tratamiento anticipado no ha sido bien estudiada, por lo que no se recomienda su uso. La profilaxis universal constituye la mejor estrategia para la prevención de la enfermedad por CMV en los receptores de trasplante de pulmón. No hay un consenso en la comunidad científica acerca de la duración de la profilaxis, pero las guías 2011 de GESITRASEIMC/ REIPI 2011 sobre prevención y tratamiento de la infección por CMV en pacientes trasplantados de órgano sólido recomiendan prolongar 6 meses postrasplante con valganciclovir, excepto en los casos de D+/R–, que es hasta el año si existen dificultades de monitorización. El futuro de la prevención de la enfermedad por CMV debería pasar por las estrategias “inmunoguiadas”.
Palabras clave:
Citomegalovirus
Trasplante de pulmón
Profilaxis
Abstract
Lung transplant recipients, more than other organ transplant recipients, are at particular risk for cytomegalovirus (CMV) infection and disease. CMV prevention avoids the indirect effects of this virus, such as opportunistic fungal infections and obliterative bronchiolitis, the latter being the major limiting factor in the long-term success of lung-transplantation. CMV prevention strategies have significantly reduced CMV disease and CMV-related mortality. Two major strategies are commonly used for CMV prevention: universal prophylaxis and preemptive therapy. In lung transplant recipients, the efficacy and safety of preemptive treatment have not been studied and therefore, cannot be recommended. Universal prophylaxis is the best strategy for preventing CMV disease in lung transplant recipients. There is no consensus on the optimal duration of prophylaxis, but the recently published GESITRA-SEIMC/REIPI 2011 Guidelines for the management of CMV infection in solid-organ transplant patients recommend 6 months posttransplantation. In D+/R− recipients, this period can be prolonged to 12 months if there are difficulties in monitoring at 6 months posttransplantation. The future of prevention will probably depend on immunoguided strategies.
Keywords:
Cytomegalovirus
Lung transplantation
Prophylaxis
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