Prevention of cytomegalovirus disease in transplant recipients

Winston, D J

doi:10.1016/s0140-6736(95)92401-9

Cited by 30 publications

(7 citation statements)

References 11 publications

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“…1,2 Recipients who are CMVnegative and who receive a transplant from a CMVpositive donor are at highest risk for disease (40 to 73 percent), CMV-positive recipients are at moderate risk (6 to 38 percent), and CMV-negative recipients who receive a transplant from a CMV-negative donor are at the lowest risk (<1 percent). [1][2][3][4][5][6][7][8][9][10][11][12][13] The heavy use of immunosuppressants also increases the risk. 1,[14][15][16] Manifestations of CMV disease range from a mild viral syndrome to severe end-organ involvement (e.g., pneumonitis, hepatitis, and gastrointestinal disease).…”

Section: Introductionmentioning

confidence: 99%

“…1,[14][15][16] Manifestations of CMV disease range from a mild viral syndrome to severe end-organ involvement (e.g., pneumonitis, hepatitis, and gastrointestinal disease). 1,9,10 Indirect evidence identifies CMV as a risk factor for acute graft rejection, 1,11,12 which is correlated with poor long-term graft survival. [13][14][15] Through its effects on the immune system, CMV also increases the risk of fungal and other superinfections in transplant recipients.…”

Section: Introductionmentioning

confidence: 99%

“…17 The availability of effective therapy [18][19][20] has reduced this figure significantly among renal-transplant recipients, 8,21 but the increased morbidity and overall costs of transplantation associated with CMV persist. 10,22 High-dose oral acyclovir is well tolerated, but prophylactic use of acyclovir has not gained wide acceptance 9 despite the fact that it reduces the risk of CMV disease among recipients of renal [23][24][25] and other solid-organ [26][27][28] transplants. The limited efficacy of acyclovir may be a result of its low oral bioavailability and the low in vitro sensitivity of CMV to the drug.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Valacyclovir for the Prevention of Cytomegalovirus Disease after Renal Transplantation

Lowance¹,

Neumayer²,

Legendre³

et al. 1999

N Engl J Med

657

153

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Valacyclovir for the Prevention of Cytomegalovirus Disease after Renal Transplantation

Lowance¹,

Neumayer²,

Legendre³

et al. 1999

N Engl J Med

657

153

View full text Add to dashboard Cite

show abstract

“…These include long-term administration of intravenous ganciclovir, pre-emptive therapy with ganciclovir, long-term administration of high-dose acyclovir, and CMV hyperimmune or standard intravenous immune globulin [1,2,3,4,5,6,7,8,9,10,11]. Although prophylactic therapy has been considerably improved in recent years, the prevention of the CMV transmission by blood products remains very important.…”

Section: Introductionmentioning

confidence: 99%

Acute cytomegalovirus infections in blood donors are indicated by increased serum neopterin concentrations

Schennach¹,

Hessenberger²,

Mayersbach³

et al. 2002

Med Microbiol Immunol

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In Austria serum neopterin measurement was introduced as an additional unspecific screening marker for the detection of routinely unscreened viral infections in blood donations in 1994. This study was performed to test for associations between serum neopterin concentrations in blood donations and cytomegalovirus infections of the donors. All consecutive blood donations from volunteer blood donors collected during 1 year were incorporated into the study. Serum neopterin concentrations were measured by enzyme-linked immunosorbent assay (ELISA), and each donation of donors with CMV seronegativity or unknown CMV status was also screened for CMV antibodies by CMV IgG/IgM antibody ELISA. Data of donors who had two or more donations within this period were retrospectively analyzed for CMV seroconversions. CMV seroconversion was defined as a change in the donor's CMV status from antibody negative to positive. Frozen, stored plasma samples of the matching donors were tested for CMV IgM antibodies to confirm seroconversion. CMV seroconversions were classified by antibody patterns. In total, 56,068 consecutive blood donations were given by 44,427 volunteer donors. Among these, 9,105 had more than one donation during the observation period, and 4,329 (47.5%) out of these repeated donors were initially CMV antibody negative, of whom 36 were recruited as candidates for CMV seroconversion; 20 conversions were confirmed. All early infections ( n=8) were associated with neopterin concentrations of more than 13 nmol/l (98th percentile of all donations = 12.1 nmol/l) and all donations were excluded from transfusion solely on the basis of their elevated neopterin level. In addition, 17% of late and carrier states ( n=12) showed elevated neopterin concentrations. Acute CMV infections among blood donors presented with elevated serum neopterin concentrations even before CMV IgG/IgM antibodies were detectable.

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“…However, controversy abounds regarding an optimal approach towards the prevention. Ganciclovir administered for 100 days after liver transplantation was effective against CMV disease, both in CMV-seropositive patients and in CMV-seronegative recipients of seropositive allografts [21]. Oral ganciclovir for 98 days was associated with a significantly lower rate of CMV disease in all liver transplant patients including those at risk for primary CMV infection [22].…”

Section: Cytomegalovirusmentioning

confidence: 99%

Recent advances in the management of infections in liver transplant recipients

Singh¹

2001

Curr Infect Dis Rep

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Antimicrobial-resistant bacteria (vancomycin-resistant enterococci and Staphylococcus aureus) have emerged as leading pathogens in liver transplant recipients. Liver transplant recipients have also been shown to be uniquely more susceptible to harboring extended-spectrum beta-lactamase-producing Enterobacteriaceae. The frequency of mycelial fungal infections has increased; however, effective prophylaxis and management of these infections remains suboptimal. Emerging reports have highlighted the morbidity due to novel herpesviruses in these patients. Finally, the emergence of ganciclovir resistance in cytomegalovirus has implications relevant for all solid organ transplant recipients.

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Prevention of cytomegalovirus disease in transplant recipients

Cited by 30 publications

References 11 publications

Valacyclovir for the Prevention of Cytomegalovirus Disease after Renal Transplantation

Valacyclovir for the Prevention of Cytomegalovirus Disease after Renal Transplantation

Acute cytomegalovirus infections in blood donors are indicated by increased serum neopterin concentrations

Recent advances in the management of infections in liver transplant recipients

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