Profilaxis de la infección por citomegalovirus en el trasplante renal | Enfermedades Infecciosas y Microbiología Clínica

Article information

Resumen

La infección por citomegalovirus (CMV) sigue representando un problema muy importante para los pacientes con trasplante renal y condiciona no sólo enfermedad visceral o síndromes febriles, sino que colabora en el desarrollo de rechazo agudo y fallo crónico del injerto. La profilaxis con valganciclovir ha supuesto un avance muy notable en el control de esta infección, pero todavía se producen casos de infección tardía por CMV, especialmente cuando se utiliza profilaxis universal. La utilización de profilaxis con valganciclovir durante 200 días es más eficaz que la profilaxis durante 100 días, pero no evita por completo este problema. La profilaxis basada en la detección de viremia por CMV (profilaxis anticipada o preemptive therapy) podría evitar el desarrollo de enfermedad por CMV tardía, pero tiene como inconveniente que exige una monitorización más estrecha del paciente, y que no evita el desarrollo de viremia y sus posibles consecuencias a largo plazo. En este artículo se revisan las recomendaciones actuales de profilaxis de la enfermedad por CMV en el trasplante renal.

Palabras clave:

Citomegalovirus

Profilaxis

Trasplante renal

Abstract

Cytomegalovirus (CMV) infection remains a major problem in renal transplant recipients. CMV produces not only febrile syndromes and/or visceral disease but also contributes to the development of acute rejection and chronic graft failure. Valganciclovir prophylaxis has represented a major advance in controlling this infection, but late CMV infection after prophylaxis can occur, especially when universal prophylaxis is used. The use of valganciclovir prophylaxis for 200 days is more effective than prophylaxis for 100 days but does not completely prevent this problem. Prophylaxis based on the detection of CMV viremia (early prophylaxis or preemptive therapy) may prevent the development of delayed CMV disease, but has the disadvantage of requiring more intensive monitoring of viremia and does not prevent the development of viremia and its potential consequences in the long term. This article reviews current recommendations for prophylaxis of CMV disease in renal transplantation.

Keywords:

Cytomegalovirus

Prophylaxis

Renal transplantation

Full text is only aviable in PDF

Bibliografía

[1.]

A. Humar, D. Snydman.

Cytomegalovirus in solid organ transplant recipients.

Am J Transplant, 9 (2009), pp. s78-s86

http://dx.doi.org/10.1111/j.1600-6143.2009.02897.x | Medline

[2.]

J.K. Preiksaitis, D.C. Brennan, J. Fishman, U. Allen.

Canadian society of transplantation consensus workshop on cytomegalovirus managementi in solid organ transplantation final report.

Am J Transplant, 5 (2005), pp. 218-227

http://dx.doi.org/10.1111/j.1600-6143.2004.00692.x | Medline

[3.]

C.V. Paya.

Prevention of cytomegalovirus disease in recipients of solid-organ transplants.

Clin Infect Dis, 32 (2001), pp. 596-603

http://dx.doi.org/10.1086/318724 | Medline

[4.]

T. Mazzulli, L.W. Drew, B. Yen-Lieberman, D. Jekic-McMullen, D.J. Kohn, C. Isada, et al.

Multicenter comparison of the digene hybrid capture CMV DNA assay (version 2.0), the pp65 antigenemia assay, and cell culture for detection of cytomegalovirus viremia.

J Clin Microbiol, 37 (1999), pp. 958-963

[5.]

A.M. Caliendo, K. St. George, S.Y. Kao, J. Allega, B.H. Tan, R. LaFontaine, et al.

Comparison of quantitative cytomegalovirus (CMV) PCR in plasma and CMV antigenemia assay: Clinical utility of the prototype AMPLICOR CMV MONITOR test in transplant recipients.

J Clin Microbiol, 38 (2000), pp. 2122-2127

Medline

[6.]

C. Díaz-Pedroche, C. Lumbreras, R. San Juan, D. Folgueira, A. Andrés, J. Delgado, et al.

Valganciclovir preemptive therapy for the prevention of cytomegalovirus disease in high-risk seropositive solid-organ transplant recipients.

Transplantation, 82 (2006), pp. 30-35

http://dx.doi.org/10.1097/01.tp.0000225830.76907.d0 | Medline

[7.]

V. Kliem, L. Fricke, T. Wollbrink, M. Burg, J. Radermacher, F. Rohde.

Improvement in long-term renal graft survival due to CMV prophylaxis with oral ganciclovir: Results of a randomized clinical trial.

Am J Transplant, 8 (2008), pp. 975-983

http://dx.doi.org/10.1111/j.1600-6143.2007.02133.x | Medline

[8.]

H.Y. Sun, M.M. Wagener, N. Singh.

Prevention of posttransplant cytomegalovirus disease and related outcomes with valganciclovir: a systematic review.

Am J Transplant, 8 (2008), pp. 2111-2118

http://dx.doi.org/10.1111/j.1600-6143.2008.02369.x | Medline

[9.]

E.M. Hodson, J.C. Craig, G.F. Strippoli, A.C. Webster.

Antiviral medications for preventing cytomegalovirus disease in solid organ transplant recipients.

Cochrane Database Syst Rev, (2005),

[10.]

A. Asberg, A. Humar, H. Rollag, A.G. Jardine, H. Mouas, M.D. Pescovitz, et al.

Oral valganciclovir is noninferior to intravenous ganciclovir for the treatment of cytomegalovirus disease in solid organ transplant recipients.

Am J Transplant, 7 (2007), pp. 2106-2113

http://dx.doi.org/10.1111/j.1600-6143.2007.01910.x | Medline

[11.]

H.H. Balfour Jr., B.A. Chace, J.T. Stapleton, R.L. Simmons, D.S. Fryd.

A randomized, placebo-controlled trial of oral acyclovir for the prevention of cytomegalovirus disease in recipients of renal allografts.

N Engl J Med, 320 (1989), pp. 1381-1387

http://dx.doi.org/10.1056/NEJM198905253202105 | Medline

[12.]

D. Lowance, H.H. Neumayer, C.M. Legendre, J.P. Squifflet, J. Kovarik, P.J. Brennan, et al.

Valacyclovir for the prevention of cytomegalovirus disease after renal transplantation. International Valacyclovir Cytomegalovirus Prophylaxis Transplantation Study Group.

N Engl J Med, 340 (1999), pp. 1462-1470

http://dx.doi.org/10.1056/NEJM199905133401903 | Medline

[13.]

V. Kliem, L. Fricke, T. Wollbrink, M. Burg, J. Radermacher, F. Rohde.

Improvement in long-term renal graft survival due to CMV prophylaxis with oral ganciclovir: results of a randomized clinical trial.

Am J Transplant, 8 (2008), pp. 975-983

http://dx.doi.org/10.1111/j.1600-6143.2007.02133.x | Medline

[14.]

C. Paya, A. Humar, E. Domínguez, K. Washburn, E. Blumberg, B. Alexander, et al.

Efficacy and safety of valganciclovir vs. oral ganciclovir for prevention of cytomegalovirus disease in solid organ transplant recipients.

Am J Transplant, 4 (2004), pp. 611-620

http://dx.doi.org/10.1111/j.1600-6143.2004.00382.x | Medline

[15.]

A. Humar, Y. Lebranchu, F. Vincenti, E.A. Blumberg, J.D. Punch, A.P. Limaye, et al.

The efficacy and safety of 200 days valganciclovir cytomegalovirus prophylaxis in high-risk kidney transplant recipients.

Am J Transplant, 10 (2010), pp. 1228-1237

[16.]

O. Manuel, J.P. Venetz, J. Fellay, J.B. Wasserfallen, N. Sturzenegger, M. Fontana, et al.

Efficacy and safety of universal valganciclovir prophylaxis combined with a tacrolimus/mycophenolate-based regimen in kidney transplantation.

Swiss Med Wkly, 137 (2007), pp. 669-676

http://dx.doi.org/2007/47/smw-11961 | Medline

[17.]

P.L. Hibberd, N.E. Tolkoff-Rubin, D. Conti, F. Stuart, J.R. Thistlethwaite, J.F. Neylan, et al.

Preemptive ganciclovir therapy to prevent cytomegalovirus disease in cytomegalovirus antibody-positive renal transplant recipients. A randomized controlled trial.

Ann Intern Med, 123 (1995), pp. 18-26

Medline

[18.]

F.L. Luan, M. Kommareddi, A.O. Ojo.

Universal prophylaxis is cost effective in cytomegalovirus serology-positive kidney transplant patients.

Transplantation, 27 (2011), pp. 237-244

[19.]

S. Sagedal, K.P. Nordal, A. Hartmann, K. Midtvedt, A. Foss, A. Asberg, et al.

Pre-emptive therapy of CMVpp65 antigen positive renal transplant recipients with oral ganciclovir: a randomized, comparative study.

Nephrol Dial Transplant, 18 (2003), pp. 1899-1908

Medline

[20.]

O. Len, J. Gavaldà, J.M. Aguado, N. Borrell, C. Cervera, J.M. Cisneros, et al.

RESITRA. Valganciclovir as treatment for cytomegalovirus disease in solid organ transplant recipients.

Clin Infect Dis, 46 (2008), pp. 20-27

http://dx.doi.org/10.1086/523590 | Medline

[21.]

T. Reischig, P. Jindra, O. Hes, M. Svecová, J. Klaboch, V. Treska.

Valacyclovir prophylaxis versus preemptive valganciclovir therapy to prevent cytomegalovirus disease after renal transplantation.

Am J Transplant, 8 (2008), pp. 69-77

http://dx.doi.org/10.1111/j.1600-6143.2007.02031.x | Medline

[22.]

M.T. Van der Beek, S.P. Berger, A.C. Vossen, C.S. Van der Blij-de Brouwer, R.R. Press, J.W. De Fijter, et al.

Preemptive versus sequential prophylactic-preemptive treatment regimens for cytomegalovirus in renal transplantation: comparison of treatment failure and antiviral resistance.

Transplantation, 89 (2010), pp. 320-326

http://dx.doi.org/10.1097/TP.0b013e3181bc0301 | Medline

[23.]

F. López-Medrano, B. Rueda, M. Lizasoain, R.S. Juan, D. Folgueira, A. Andrés, et al.

Preemptive therapy is not adequate for prevention of cytomegalovirus disease in pancreas-kidney transplant recipients.

Transpl Infect Dis, 11 (2009), pp. 400-404

http://dx.doi.org/10.1111/j.1399-3062.2009.00416.x | Medline

[24.]

O.J. Benmarzouk-Hidalgo, J.M. Cisneros, E. Cordero, A. Martín-Peña, B. Sánchez, C. Martín-Gandul, et al.

Therapeutic effect of the acquisition of cytomegalovirusspecific immune response during preemptive treatment.

Transplantation, 27 (2011), pp. 927-931

[25.]

A.C. Kalil, J. Levitsky, E. Lyden, J. Stoner, A.G. Freifeld.

Meta-analysis: the efficacy of strategies to prevent organ disease by cytomegalovirus in solid organ transplant recipients.

Ann Intern Med, 143 (2005), pp. 870-880

Medline

Indexed in:

Follow us:

Subscribe:

Indexed in:

Follow us:

Subscribe:

Subscribe to our newsletter