Cytomegalovirus in transplantation - challenging the status quo.

Details

Serval ID
serval:BIB_5893AA82A092
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Cytomegalovirus in transplantation - challenging the status quo.
Journal
Clinical Transplantation
Author(s)
Fishman J.A., Emery V., Freeman R., Pascual M., Rostaing L., Schlitt H.J., Sgarabotto D., Torre-Cisneros J., Uknis M.E.
ISSN
0902-0063[print], 0902-0063[linking]
Publication state
Published
Issued date
04/2007
Volume
21
Number
2
Pages
149-158
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't ; Review
Abstract
BACKGROUND: Cytomegalovirus (CMV) infection of solid organ transplant (SOT) recipients causes both ''direct'' and ''indirect'' effects including allograft rejection, decreased graft and patient survival, and predisposition to opportunistic infections and malignancies. Options for CMV prevention include pre-emptive therapy, whereby anti-CMV agents are administered based on sensitive viral assays, or universal prophylaxis of all at-risk patients. Each approach has advantages and disadvantages in terms of efficacy, costs, and side effects. Standards of care for prophylaxis have not been established.
METHODS: A committee of international experts was convened to review the available data regarding CMV prophylaxis and to compare preventative strategies for CMV after transplantation from seropositive donors or in seropositive recipients.
RESULTS: Pre-emptive therapy requires frequent monitoring with subsequent treatment of disease and associated costs, while universal prophylaxis results in greater exposure to potential toxicities and costs of drugs. The advantages of prophylaxis include suppressing asymptomatic viremia and prevention of both direct and indirect effects of CMV infection. Meta analyses reveal decreased in mortality for patients receiving CMV prophylaxis. Costs associated with prophylaxis are less than for routine monitoring and pre-emptive therapy. The optimal duration of antiviral prophylaxis remains undefined. Extended prophylaxis may improve clinical outcomes in the highest-risk patient populations including donor-seropositive/recipient-seronegative renal transplants and in CMV-infected lung and heart transplantation.
CONCLUSIONS: Prophylaxis is beneficial in preventing direct and indirect effects of CMV infection in transplant recipients, affecting both allograft and patient survival. More studies are necessary to define optimal prophylaxis regimens.
Keywords
Antiviral Agents/therapeutic use, Comorbidity, Cytomegalovirus Infections/drug therapy, Cytomegalovirus Infections/etiology, Ganciclovir/analogs &amp, derivatives, Ganciclovir/therapeutic use, Graft Rejection, Humans, Liver Transplantation, Neutropenia/epidemiology, Neutropenia/etiology, Organ Transplantation, Postoperative Complications/virology, Virus Replication
Pubmed
Web of science
Create date
29/01/2008 13:53
Last modification date
20/08/2019 14:12
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