Cytomegalovirus infection in renal transplantation: clinical aspects, management and the perspectives

Abstract

Cytomegalovirus infection is one of most frequent infectious complications after renal transplantation, and can be classified as primo-infection, when the transmission occurs through the graft, or reactivation, when the recipient is cytomegalovirus seropositive. After transplantation, cytomegalovirus can appear as an infection, when the patient presents with evidence of viral replication without symptoms or disease, which has two clinical spectra: typical viral syndrome or invasive disease, which is a less common form. Their effects can be classified as direct, while the disease is developed, or indirect, with an increase of acute rejection and chronic allograft dysfunction risks. Diagnosis must be made based on viremia by one of the standardized methods: antigenemia or PCR, which is more sensitive. The risk factors related to infection after transplantation are the serologic matching (positive donor and negative recipient) and anti-lymphocyte antibody drugs. One of the strategies to reduce risk of disease should be chosen for patients at high risk: preemptive treatment or universal prophylaxis. Recent clinical research has described ganciclovir resistance as an emergent problem in management of cytomegalovirus infection. Two types of mutation that cause resistance were described: UL97 (most frequent) and UL54. Today, sophisticated methods of immunologic monitoring to detect specific T-cell clones against cytomegalovirus are used in clinical practice to improve the management of high-risk patients after renal transplantation.

Impact of cytomegalovirus reactivation on clinical outcomes in immunocompetent critically ill patients: protocol for a systematic review and meta-analysis

“…CMV reactivation in critically ill patients is well-recognized with as high as 71 % incidence [ 5 ]. The consequences of CMV reactivation in immunocompromised patient populations, such as solid organ transplantation, have been well described [ 6 ]. However, the clinical significance in immunocompetent patients remains controversial.…”

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“…[37][38][39] Along with, the prevention of opportunistic infections is critical during posttransplant period. 40,41 The preferred drug-induced immunocompromised conditions during transplant, thus, seek a continuous antimicrobial treatment regimen.…”

A nurse‐coordinated model of care versus usual care for chronic kidney disease: meta‐analysis

“…Various prospective studies, conducted in different clinical centres, argued that a nurse-centred intensive care management is more beneficial for patients with CKD when compared with usual care model (Goodman 2010, Requiao-Moura et al 2015a). However, systematic review or meta-analysis of these studies has not been conducted to attain an objectively convincing conclusion by evaluating the clinical outcomes under the same conditions.…”