metricas
covid
Buscar en
Enfermedades Infecciosas y Microbiología Clínica
Toda la web
Inicio Enfermedades Infecciosas y Microbiología Clínica Esquemas de prevención de la infección por citomegalovirus: terapia anticipada...
Información de la revista
Vol. 29. Núm. S6.
La infección por citomegalovirus en el trasplante de órgano sólido: nuevas evidencias de un patógeno clásico
Páginas 33-37 (diciembre 2011)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 29. Núm. S6.
La infección por citomegalovirus en el trasplante de órgano sólido: nuevas evidencias de un patógeno clásico
Páginas 33-37 (diciembre 2011)
Acceso a texto completo
Esquemas de prevención de la infección por citomegalovirus: terapia anticipada frente a profilaxis universal
Prevention of cytomegalovirus infection: preemptive therapy versus universal prophylaxis
Visitas
7913
Elisa Cordero Matíaa,
Autor para correspondencia
mcordero@cica.es

Autor para correspondencia.
, Óscar Lenb
a Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, Sevilla, España
b Servicio de Enfermedades Infecciosas, Hospital Vall d’Hebron, Barcelona, España
Este artículo ha recibido
Información del artículo
Resumen

A pesar de los avances en el diagnóstico y tratamiento de la infección por citomegalovirus (CMV), ésta sigue siendo una importante causa de morbilidad en el receptor de trasplante de órgano sólido (TOS). Las 2 principales estrategias para la prevención de la enfermedad por CMV son la profilaxis universal y el tratamiento anticipado. Ambas estrategias, comparadas con placebo, son eficaces en la prevención de la enfermedad por CMV en los receptores de TOS, según varios metaanálisis, y cada una de ellas presenta ventajas e inconvenientes. No obstante hay pocos estudios que hayan comparado ambas aproximaciones a la prevención de la enfermedad por CMV en el receptor de TOS. En este artículo se realiza una revisión de las indicaciones de cada una de estas estrategias y de los principales estudios donde se fundamentan.

Palabras clave:
Citomegalovirus
Trasplante de órgano sólido
Prevención
Profilaxis universal
Tratamiento anticipado
Abstract

Despite the advances made in the diagnosis and treatment of cytomegalovirus (CMV) infection, this pathogen continues to cause substantial morbidity in solid organ transplant (SOT) recipients. The two main strategies for the prevention of CMV disease are universal prophylaxis and preemptive therapy. Several meta-analyses have found that both strategies are effective in the prevention of CMV disease in SOT recipients compared with placebo, each with its own advantages and disadvantages. Nevertheless, few studies have compared the two approaches to CMV disease in SOT recipients. The present article provides a review of the indications of each of these strategies and the main studies on which they are based.

Keywords:
Cytomegalovirus
Solid organ transplantation
Prevention
Universal prophylaxis
Preemptive treatment
El Texto completo está disponible en PDF
Bibliografía
[1.]
A.T. Rowshani, F.J. Bemelman, E.M. Van Leeuwen, R.A. Van Lier, I.J. Berge.
Clinical and immunologic aspects of gytomegalovirus infection in solid organ transplant recipients.
Transplantation, 79 (2005), pp. 381-386
[2.]
S.K. Arthurs, A.J. Eid, R.A. Pedersen, R.A. Dierkhising, W.K. Kremers, R. Patel, et al.
Delayed-onset primary cytomegalovirus disease after liver transplantation.
Liver Transpl, 13 (2007), pp. 1703-1709
[3.]
A.P. Limaye, R. Bakthavatsalam, H.W. Kim, S.E. Randolph, J.B. Halldorson, P.J. Healey, et al.
Impact of cytomegalovirus in organ transplant recipients in the era of antiviral prophylaxis.
Transplantation, 81 (2006), pp. 1645-1652
[4.]
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, (2008), pp. CD003774
[5.]
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
[6.]
L.N. Small, J. Lau, D.R. Snydman.
Preventing post-organ transplantation cytomegalovirus disease with ganciclovir: a meta-analysis comparing prophylactic and preemptive therapies.
Clin Infect Dis, 43 (2006), pp. 869-880
[7.]
A.P. Limaye, L. Corey, D.M. Koelle, C.L. Davis, M. Boeckh.
Emergence of ganciclovirresistant cytomegalovirus disease among recipients of solid-organ transplants.
[8.]
E. Gane, F. Saliba, G.J. Valdecasas, J. O’Grady, M.D. Pescovitz, S. Lyman, et al.
Randomised trial of efficacy and safety of oral ganciclovir in the prevention of cytomegalovirus disease in liver-transplant recipients. The Oral Ganciclovir International Transplantation Study Group.
Lancet, 350 (1997), pp. 1729-1733
[9.]
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
[10.]
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
[11.]
A.C. Kalil, D.F. Florescu.
Why valganciclovir should not be indicated for liver recipients and high-dose aciclovir should not be removed fom international cytomegalovirus guidelines.
Transplantation, 91 (2011), pp. e8-e9
[12.]
A. Humar, A.P. Limaye, E.A. Blumberg, I.A. Hauser, F. Vincenti, A.G. Jardine, et al.
Extended valganciclovir prophylaxis in D+/R– kidney transplant recipients is associated with long-term reduction in cytomegalovirus disease: two-year results of the IMPACT study.
Transplantation, 90 (2010), pp. 1427-1431
[13.]
A. Humar, D. Kumar, J. Preiksaitis, G. Boivin, D. Siegal, J. Fenton, et al.
A trial of valganciclovir prophylaxis for cytomegalovirus prevention in lung transplant recipients.
Am J Transplant, 5 (2005), pp. 1462-1468
[14.]
M.R. Zamora, M.R. Nicolls, T.N. Hodges, J. Marquesen, T. Astor, T. Grazia, et al.
Following universal prophylaxis with intravenous ganciclovir and cytomegalovirus immune globulin, valganciclovir is safe and effective for prevention of CMV infection following lung transplantation.
Am J Transplant, 4 (2004), pp. 1635-1642
[15.]
R.H. Rubin, S.A. Kemmerly, D. Conti, M. Doran, B.M. Murray, J.F. Neylan, et al.
Prevention of primary cytomegalovirus disease in organ transplant recipients with oral ganciclovir or oral acyclovir prophylaxis.
Transpl Infect Dis, 23 (2000), pp. 112-117
[16.]
D.J. Winston, D. Wirin, A. Shaked, R.W. Busuttil.
Randomised comparison of ganciclovir and high-dose acyclovir for long-term cytomegalovirus prophylaxis in livertransplant recipients.
Lancet, 346 (1995), pp. 69-74
[17.]
M. Martín, R. Mañez, P. Linden, D. Estores, J. Torre-Cisneros, S. Kusne, et al.
A prospective randomized trial comparing sequential ganciclovir-high dose acyclovir to high dose acyclovir for prevention of cytomegalovirus disease in adult liver transplant recipients.
Transplantation, 58 (1994), pp. 779-785
[18.]
D.J. Winston, R.W. Busuttil.
Randomized controlled trial of oral ganciclovir versus oral acyclovir after induction with intravenous ganciclovir for long-term prophylaxis of cytomegalovirus disease in cytomegalovirus-seropositive liver transplant recipients.
Transplantation, 75 (2003), pp. 229-233
[19.]
A. Humar, D. Snydman, The AST Infectious Diseases Community of Practice.
Cytomegalovirus in solid organ transplant recipients.
Am J Transplant, 9 (2009), pp. S78-S86
[20.]
C.N. Kotton, D. Kumar, A.M. Caliendo, A. Asberg, S. Chou, D.R. Snydman, et al.
International consensus guidelines on the management of cytomegalovirus in solid organ transplantation.
Transplantation, 89 (2010), pp. 779-795
[21.]
J. Torre-Cisneros, M.C. Fariñas, J.J. Castón, J.M. Aguado, S. Cantisán, J. Carratalá, et al.
Recomendaciones GESITRA-SEIMC/REIPI sobre el manejo de la infección por citomegalovirus en pacientes trasplantados de órgano sólido.
Enferm Infecc Microbiol Clin, 29 (2011), pp. 735-758
[22.]
H. Valantine, H. Luikart, R. Doyle, J. Theodore, S. Hunt, P. Oyer, et al.
Impact of cytomegalovirus hyperimmune globulin on outcome after cardiothotracic transplantation: a comparative study of combined prophylaxis with CMV hyperimmune globulin plus ganciclovir versus ganciclovir alone.
Transplantation, 72 (2001), pp. 1647-1652
[23.]
P.D. Griffiths, A. Stanton, E. McCarrell, C. Smith, M. Osman, M. Harber, et al.
Cytomegalovirus glycoprotein-B vaccine with MF59 adjuvant in transplant recipients: a phase 2 randomised placebo-controlled trial.
Lancet, 377 (2011), pp. 1256-1263
[24.]
A.C. Kalil, C. Mindru, D.F. Florescu.
Effectiveness of valganciclovir 900mg versus 450mg for cytomegalovirus prophylaxis in transplantation: direct and indirect treatment comparison meta-analysis.
Clin Infect Dis, 52 (2011), pp. 313-321
[25.]
G. Boivin, N. Goyette, C. Gilbert, N. Roberts, K. Macey, C. Paya, et al.
Absence of cytomegalovirus-resistance mutations after valganciclovir prophylaxis, in a prospective multicenter study of solid-organ transplant recipients.
J Infect Dis, 189 (2004), pp. 1615-1618
[26.]
A.P. Limaye, R. Bakthavatsalam, H.W. Kim, C.S. Kuhr, J.B. Halldorson, P.J. Healey, et al.
Late-onset cytomegalovirus disease in liver transplant recipients despite antiviral prophylaxis.
Transplantation, 78 (2004), pp. 1390-1396
[27.]
R.R. Razonable, A. Rivero, A. Rodríguez, J. Wilson, J. Daniels, G. Jenkins, et al.
Allograft rejection predicts the occurrence of late-onset cytomegalovirus (CMV) disease among CMV-mismatched solid organ transplant patients receiving prophylaxis with oral ganciclovir.
J Infect Dis, 184 (2001), pp. 1461-1464
[28.]
A. Humar, C. Paya, M.D. Pescovitz, E. Domínguez, K. Washburn, E. Blumberg, et al.
Clinical utility of cytomegalovirus viral load testing for predicting CMV disease in D+/R– solid organ transplant recipients.
Am J Transplant, 4 (2004), pp. 644-649
[29.]
C.V. Paya, J.A. Wilson, M.J. Espy, I.G. Sia, M.J. DeBernardi, T.F. Smith, et al.
Preemptive use of oral ganciclovir to prevent cytomegalovirus infection in liver transplant patients: a randomized, placebo-controlled trial.
J Infect Dis, 185 (2002), pp. 854-860
[30.]
N. Singh, V.L. Yu.
Preemptive therapy for cytomegalovirus.
Liver Transpl, 12 (2006), pp. 327
[31.]
N. Singh, C. Wannstedt, L. Keyes, D. Mayher, L. Tickerhoof, M. Akoad, et al.
Valganciclovir as preemptive therapy for cytomegalovirus in cytomegalovirus-seronegative liver transplant recipients of cytomegalovirus-seropositive donor allografts.
Liver Transpl, 14 (2008), pp. 240-244
[32.]
C. Mengelle, C. Pasquier, L. Rostaing, K. Sandres-Sauné, J. Puel, L. Berges, et al.
Quantitation of human cytomegalovirus in recipients of solid organ transplants by real-time quantitative PCR and pp65 antigenemia.
J Med Virol, 69 (2003), pp. 225-231
[33.]
O.J. Benmarzouk-Hidalgo, E. Cordero, A. Martín-Peña, E. García-Prado, M.A. Gentil, M.A. Gómez-Bravo, et al.
Prevention of cytomegalovirus disease using pre-emptive treatment after solid organ transplant in patients at high risk for cytomegalovirus infection.
Antivir Ther, 14 (2009), pp. 641-647
[34.]
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, 91 (2011), pp. 927-933
[35.]
N. Singh, C. Wannstedt, L. Keyes, T. Gayowski, M.M. Wagener, T.V. Cacciarelli.
Efficacy of valganciclovir administered as preemptive therapy for cytomegalovirus disease in liver transplant recipients: impact on viral load and late-onset cytomegalovirus disease.
Transplantation, 79 (2005), pp. 85-90
[36.]
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
[37.]
G.F. Strippoli, E.M. Hodson, C. Jones, J.C. Craig.
Preemptive treatment for cytomegalovirus viremia to prevent cytomegalovirus disease in solid organ transplant recipients.
Transplantation, 81 (2006), pp. 139-145
[38.]
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
[39.]
D. Abate, A. Saldan, M. Fiscon, S. Cofano, A. Paciolla, L. Furian, et al.
Evaluation of cytomegalovirus (CMV)-specific T cell immune reconstitution revealed that baseline antiviral immunity, prophylaxis, or preemptive therapy but not antithymocyte globulin treatment contribute to CMV-specific T cell reconstitution in kidney transplant recipients.
J Infect Dis, 202 (2010), pp. 585-594
[40.]
J.A. Khoury, G.A. Storch, D.L. Bohl, R.M. Schuessler, S.M. Torrence, M. Lockwood, et al.
Prophylactic versus preemptive oral valganciclovir for the management of cytomegalovirus infection in adult renal transplant recipients.
Am J Transplant, 6 (2006), pp. 2134-2143
[41.]
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
[42.]
E.M. Hodson, C.A. Jones, A.C. Webster, G.F. Strippoli, P.G. Barclay, K. Kable, et al.
Antiviral medications to prevent cytomegalovirus disease and early death in recipients of solid-organ transplants: a systematic review of randomised controlled trials.
Lancet, 365 (2005), pp. 2105-2115
Copyright © 2011. Elsevier España S.L.. Todos los derechos reservados
Descargar PDF
Opciones de artículo
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos