Revisiting the effects of CMV on long-term transplant outcome.
OBJECTIVE
Indirect effects of cytomegalovirus (CMV) in transplantation are of three types: increase in systemic immunosuppression, increased risk of malignancy (especially Epstein-Barr virus-related B-cell lymphoproliferative disease), and the possible contribution to allograft injury. Despite modern and potent antiviral drugs, the real impact of CMV in transplantation, especially kidney transplantation, remains a challenge because many confounding factors arise when analyzing this question.This review will fuel the discussion and review some of the recent data.


RESULTS
A recent study on cardiac allograft in mice has shown that CMV in latently infected recipients could break graft acceptance. Although the exact nature of response was not addressed, this study suggested that CMV reactivation inside the graft played an important part in graft losses. Other recent results suggest that the quality of immune response against CMV influences graft outcome in both cardiac and kidney transplant patients. Other evidence suggests the link between CMV infection, immune senescence and vascular disease in the whole population. Studies have opened the perspective for new strategies to prevent indirect effects of CMV.


CONCLUSIONS
Although a causal relationship between CMV reactivation and graft injury is supported by a large body of experimental and clinical data, definitive proof in clinical transplantation is still lacking to exclude an associative relationship. Large randomized clinical trials analyzing long-term graft survival and comparing prophylaxis with preemptive, especially D/R, is probably an efficient way to establish a causal relationship. Research on new antiviral strategies applicable over the long term is important.
Baron
Christophe
C
UPRES EA 4245 Cellules Dendritiques, Immunomodulation et Greffes, UFR de Médecine, Université François Rabelais, Tours Cedex, France. baron@med.univ-tours.fr
Forconi
Catherine
C
Lebranchu
Yvon
Y
D000818:Animals; D000998:Antiviral Agents / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000276:immunology / Q000517:prevention & control / Q000821:virology*; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control / Q000821:virology*; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects* / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014775:Virus Activation
D000998:Antiviral Agents; D007166:Immunosuppressive Agents