title: The impact of the prevention strategies on the indirect effects of CMV infection in solid organ transplant recipients.
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.
authors.affiliation: Hospital Vall d'Hebrón, Barcelona, Spain. Electronic address: aroman@vhebron.net.
authors.forename: Antonio
authors.initials: A
authors.lastname: Roman
authors.affiliation: Hospital de Bellvitge, Barcelona, Spain.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Manito
authors.affiliation: Hospital Clínic, Barcelona, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Campistol
authors.affiliation: Hospital Puerta de Hierro, Madrid, Spain.
authors.forename: Valentín
authors.initials: V
authors.lastname: Cuervas-Mons
authors.affiliation: Hospital La Fe, Valencia, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Almenar
authors.affiliation: Hospital Marqués de Valdecilla, Santander, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Arias
authors.affiliation: Hospital Marqués de Valdecilla, Santander, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Casafont
authors.affiliation: Hospital Reina Sofía, Córdoba, Spain.
authors.forename: Domingo
authors.initials: D
authors.lastname: del Castillo
authors.affiliation: Complejo Universitario A Coruña, La Coruña, Spain.
authors.forename: María G
authors.initials: MG
authors.lastname: Crespo-Leiro
authors.affiliation: Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Delgado
authors.affiliation: Clínica Universitaria de Navarra, Pamplona, Spain.
authors.forename: J Ignacio
authors.initials: JI
authors.lastname: Herrero
authors.affiliation: Hospital La Paz, Madrid, Spain.
authors.forename: Paloma
authors.initials: P
authors.lastname: Jara
authors.affiliation: Hospital 12 de Octubre, Madrid, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Morales
authors.affiliation: Hospital La Paz, Madrid, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Navarro
authors.affiliation: Hospital Clínic, Barcelona, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Oppenheimer
authors.affiliation: Hospital La Fe, Valencia, Spain.
authors.forename: Martín
authors.initials: M
authors.lastname: Prieto
authors.affiliation: Hospital Puerta de Hierro, Madrid, Spain.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Pulpón
authors.affiliation: Hospital Clínic, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Rimola
authors.affiliation: Hospital Vall d'Hebrón, Barcelona, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Serón
authors.affiliation: Hospital Puerta de Hierro, Madrid, Spain.
authors.forename: Piedad
authors.initials: P
authors.lastname: Ussetti
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods; D008297:Male; D016377:Organ Transplantation / Q000009:adverse effects* / Q000379:methods; D011322:Primary Prevention / Q000379:methods*; D011379:Prognosis; D016019:Survival Analysis
chemical_list: D000998:Antiviral Agents