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Resumen
Citomegalovirus (CMV) es el patógeno oportunista más importante en el paciente sometido a un trasplante de órgano, incrementando la mortalidad del paciente debido a efectos directos e indirectos. El factor de riesgo más importante para el desarrollo de enfermedad por CMV es la discordancia serológica para CMV entre donante y receptor (donante positivo y receptor negativo), que supone un riesgo de más del 50% de desarrollo de enfermedad por CMV si no se administra profilaxis. El uso de fármacos antivirales muy potentes para la profilaxis de esta complicación en pacientes de alto riesgo ha modificado las características de la enfermedad por CMV en esta población. Otros factores de riesgo clásicos para el desarrollo de enfermedad por CMV incluyen el desarrollo de rechazo agudo del injerto, tipo de órgano trasplantado, coinfección con otros herpesvirus y el tipo de inmunosupresores empleado. Recientemente se han descrito nuevos factores de riesgo para el desarrollo de esta complicación que incluyen las variaciones de genotipo de CMV entre donante y receptor, y alteraciones genéticas de la inmunidad innata en el receptor. En esta revisión se abordan los factores de riesgo clásicos y los últimos hallazgos descritos para el desarrollo de enfermedad por CMV en el receptor de un trasplante de órgano.
Palabras clave:
Enfermedad por CMV
Factores de riesgo
Trasplante de órgano sólido
Discordancia serológica
Rechazo agudo del injerto
Inmunosupresión
Herpesvirus
Polimorfismos genéticos
Abstract
Cytomegalovirus (CMV) is the most important opportunistic pathogen in patients undergoing solid organ transplantation and increases mortality due to both direct and indirect effects. The most important risk factor for the development of CMV disease is discordant donor-recipient CMV serology (positive donor and negative recipient), which confers more than 50% risk of developing CMV disease if no prophylaxis is given. The use of highly potent antiviral agents for CMV prophylaxis in high-risk patients has changed the characteristics of CMV disease in this population. Other classical risk factors for CMV disease include acute graft rejection, the type of organ transplanted, coinfection with other herpesviruses and the type of immunosuppressive agents employed. New risk factors for this complication have recently been described, including variations in the CMV genotype between donor and recipient and genetic alterations in the recipient's innate immunity. The present review discusses classical risk factors and the latest findings reported on the development of CMV in organ transplant recipients.
Keywords:
CMV disease
Risk factors
Solid organ transplant
Serological discordance
Acute graft rejection
Immunosuppression
Herpesvirus
Genetic polymorphisms
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