Strategies for preventing late-onset cytomegalovirus disease in organ transplant recipients.

Détails

ID Serval
serval:BIB_C299F5DA473F
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Strategies for preventing late-onset cytomegalovirus disease in organ transplant recipients.
Périodique
Trends in Transplantation
Auteur(s)
Manuel O, Pascual M.
ISSN
1887-455X
Statut éditorial
Publié
Date de publication
2010
Volume
4
Numéro
1
Pages
36-44
Langue
anglais
Résumé
Objective: The incidence of late-onset cytomegalovirus disease (i.e. disease appearing after discontinuation of antiviral prophylaxis) in solid-organ transplant recipients remains excessively high. This review will focus on describing the several strategies that could potentially reduce the incidence of late-onset cytomegalovirus disease. Methods: We reviewed the literature and presented our own clinical experience in the field. Results: The incidence of late-onset cytomegalovirus disease in recent trials can be as high as 36% in high-risk patients (donor positive/recipient negative for cytomegalovirus). The extension of antiviral prophylaxis to six months has recently proven in a prospective randomized controlled trial to be effective for reducing late-onset cytomegalovirus disease. The monitoring of cytomegalovirus viral load by PCR after the discontinuation of prophylaxis seems to be of moderate usefulness in low/intermediate-risk patients. The use of low-dose valganciclovir could reduce drug toxicity and costs while maintaining similar efficacy, but further studies are needed. A potentially interesting approach to predict the individual risk for development of cytomegalovirus disease appears to be the assessment of specific cell-mediated immune response. If cell-mediated immunity assays become widely available in transplant centers in the future, these assays may possibly be used to tailor the cytomegalovirus preventive strategy on an individual basis. Finally, recent prospective trials have evaluated novel cytomegalovirus vaccines that merit further evaluation in the transplant setting, although currently there is no cytomegalovirus vaccine that has been approved for routine clinical use. Conclusions: Several studies have recently evaluated novel strategies to reduce the incidence of late-onset cytomegalovirus disease. It is therefore expected that this improvement in preventive strategies will allow to further reduce the negative effects of cytomegalovirus disease after transplantation.
Mots-clé
Antiviral prophylaxis. Valganciclovir. Cellular immunity. Indirect effects
Création de la notice
07/03/2011 10:57
Dernière modification de la notice
20/08/2019 15:37
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