title: Significance of cytomegalovirus prophylaxis strategies and development of cancer in kidney transplant recipients.
abstract: Cytomegalovirus (CMV) infection is one of the most common complications among kidney transplant recipients; two approaches preventing this complication are currently available: universal prophylaxis (UP) and pre-emptive therapy (PT). Despite some differences, similar effectiveness and safety have been proven in several studies for both strategies. However, Spinner et al compared both treatments in 115 renal transplant recipients showing deaths were more likely to occur in patients who received UP. Most of these deaths (2/4 cases) occurred because malignancies developed. This finding is paradoxical because CMV is considered a potentially oncogenic virus and, therefore, UP (a longer therapy compared with the PT) should not be linked with the emergence of a greater number of tumors. New evidence suggests that changes in host immune response triggered by CMV infection may have a mitigating effect on the development of tumors. It is now known CMV infection produces a clonal expansion of gamma delta T lymphocytes which can elicit an aggressive response against neoplastic cells. Currently, UP is the therapy most frequently used in Colombian transplant centers; however, doses administered vary depending on several clinical and laboratory factors. There are no clinical cohorts treated with PT. Reviewing the impact of different length dosing schemes is important for creating an immune response affecting malignancy development in kidney transplant recipients.
authors.affiliation: Organ and Tissue Transplant Group, Department of Surgery, National University of Colombia, Medical School, Bogotá, Colombia. jcosoriom@unal.edu.co
authors.forename: J C
authors.initials: JC
authors.lastname: Osorio
authors.forename: R D
authors.initials: RD
authors.lastname: Medina
authors.forename: N
authors.initials: N
authors.lastname: Patiño
authors.forename: L
authors.initials: L
authors.lastname: Ricaurte
authors.forename: L
authors.initials: L
authors.lastname: Moreno
authors.forename: E
authors.initials: E
authors.lastname: Lozano
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D003105:Colombia; D003587:Cytomegalovirus / Q000378:metabolism*; D003586:Cytomegalovirus Infections / Q000517:prevention & control*; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007107:Immune System; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D009369:Neoplasms / Q000150:complications / Q000209:etiology*; D016896:Treatment Outcome; D000077562:Valganciclovir; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir