Cytomegalovirus in transplantation - challenging the status quo.

Détails

ID Serval
serval:BIB_5893AA82A092
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Titre
Cytomegalovirus in transplantation - challenging the status quo.
Périodique
Clinical Transplantation
Auteur(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]
Statut éditorial
Publié
Date de publication
04/2007
Volume
21
Numéro
2
Pages
149-158
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't ; Review
Résumé
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.
Mots-clé
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
Création de la notice
29/01/2008 13:53
Dernière modification de la notice
20/08/2019 14:12
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