[Cytomegalovirus effects in solid organ transplantation and the role of antiviral prophylaxis].
Cytomegalovirus (CMV) belongs to β-Herpesviridae family. Morbidity related to this infectious agent remains a serious concern in the context of immunosuppression. Occurence of CMV infection within the first 3 months post-renal transplantation without any antiviral prophylaxis is about 70% of patients. Direct and indirect effects of CMV infection in the setting of organ transplantation are described in this review. A 3 to 6 months course of prophylaxis with valganciclovir is advised concerning high-risk transplant recipients (D+/R-) but recommendation regarding intermediate-risk transplant recipients (CMV-seropositive patients) is still unclear. Recent studies highlight a benefit of long time prophylaxis (until 6 months) in terms of CMV disease occurence among D+/R- patients. News assays that measures IFNγ responses to a variety of CMV epitopes (Quantiferon(®) and Elispot IFNγ) are developped to predict CMV disease onset after discontinuation of antiviral prophylaxis. These assays could contribute to adapt prophylaxis to each recipient.
Weclawiak
Hugo
H
Unité de néphrologie, dialyse, transplantation multi-organes, CHU Rangueil, TSA 50032, 31059 Toulouse cedex 9, France.
Mengelle
Catherine
C
Ould Mohamed
Abdellatif
A
Izopet
Jacques
J
Rostaing
Lionel
L
Kamar
Nassim
N
D000998:Antiviral Agents / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000517:prevention & control*; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation / Q000009:adverse effects*; D000077562:Valganciclovir
D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir