The impact of the prevention strategies on the indirect effects of CMV infection in solid organ transplant recipients

Autores de IIS La Fe

• Luis Almenar Bonet

  Autor

• Jose Ignacio Herrero Sanchez

  Autor

• Luis Jara Palomares

  Autor

• Miguel Ángel Navarro Mira

  Autor

• Martín Prieto Castillo

  Autor

Participantes ajenos a IIS La Fe

• Roman A
• Manito N
• Campistol JM
• Cuervas-Mons V
• Arias M
• Casafont F
• del Castillo D
• Crespo-Leiro MG
• Delgado JF
• Morales JM
• Oppenheimer F
• Pulpón LA
• Rimola A
• Serón D
• Ussetti P
• ATOS working group

Grupos

• Dermatología y Regeneración Tisular

• Grupo de Investigación Clínica y Traslacional en Cardiología

• Hepatología experimental y Trasplante hepático

Abstract

Transplant recipients receiving immunosuppressive therapy are at increased risk of active cytomegalovirus (CMV) infection and disease. Without appropriate prophylaxis, as many as 80% of solid organ transplant recipients may experience CMV infection. In addition to the direct effects of CMV, infection may be associated with a range of indirect effects, including an increase in risk of other infections, as well as a higher incidence of rejection, graft loss and death. The indirect effects of CMV infection can vary depending on the transplanted organ. For example, CMV-infected kidney transplant recipients may be at increased risk of cardiovascular disease and diabetes, while CMV infection in liver transplant recipients may potentiate hepatitis C infection and increase the risk of post-transplant lymphoproliferative disease. Indirect effects result from a number of pathological processes, including immune modulation and immunosuppression, generation of cytotoxic, pro-inflammatory responses, and smooth muscle proliferation. Prophylactic treatment with antiviral medication can reduce the risk of CMV disease, thereby improving graft survival and overall outcomes, particularly in kidney and heart transplant recipients. Antiviral prophylaxis should be considered for all patients at risk of CMV infection after solid organ transplantation. In this paper we review the main indirect effects of CMV infection in solid organ transplant recipients, and the impact of CMV prophylaxis on these effects. (C) 2014 Elsevier Inc. All rights reserved.