Profilaxis de la infección por citomegalovirus en el trasplante renal

Aguado, José María; Gil Vernet, Salvador

doi:10.1016/S0213-005X(11)70056-8

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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

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