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      Efectos de la infección viral en el paciente trasplantado Translated title: Effects of viral infection on transplant recipients

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          Abstract

          Las infecciones virales continúan siendo una importante causa de morbimortalidad en los pacientes trasplantados. En estos pacientes, el riesgo de infección viral depende de varios factores como el tipo de trasplante, la intensidad de la inmunosupresión y la susceptibilidad del receptor. Además de efectos directos, la infección viral puede causar efectos indirectos derivados del efecto inmunomodulador de algunos virus como citomegalovirus o herpesvirus 6. Entre estos efectos se encuentran un mayor riesgo de replicación de otros virus, de rechazo, de otras infecciones oportunistas y de otras entidades específicas en cada tipo de trasplante. Los tests moleculares cuantitativos han reemplazado en la mayoría de las ocasiones a los métodos serológicos y al cultivo para el diagnóstico de estas infecciones, especialmente en el caso de citomegalovirus, virus de Epstein-Barr, y los virus de la hepatitis B y C. Sin embargo, estos avances diagnósticos no se han acompañado del desarrollo de antivirales específicos o de vacunas eficaces, por lo que las medidas de prevención continúan siendo fundamentales en estos pacientes.

          Translated abstract

          Viral infection remains an important cause of morbidity and mortality in transplant recipients. The risk of viral infection in these patients depends on several factors, such as the type of organ transplanted, the intensity of immunosuppression, and the recipient's susceptibility. In additional to direct effects, viral infection cause indirect effects, including greater risk of replication of other viruses, graft rejection, opportunistic infections and other specific entities for each type of transplant. These indirect effects result from the immunomodulatory activity of some viruses, such as cytomegalovirus and human herpes virus-6. For the most part, quantitative molecular tests have replaced serologic testing and in vitro culture for diagnosing infection. This approach is particularly prominent for cytomegalovirus, Epstein-Barr virus, hepatitis B virus, and hepatitis C virus. Despite these diagnostic advances, the development of specific antiviral agents and effective antiviral vaccines is limited. Thus, prophylactic strategies are still essential in transplant recipients.

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          Most cited references65

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          Lymphomas after solid organ transplantation: a collaborative transplant study report.

          We used the Collaborative Transplant Study database to analyze the incidence, risk, and impact of malignant lymphomas in approximately 200,000 organ transplant recipients. Over a 10-year period, the risk in renal transplant recipients was 11.8-fold higher than that in a matched nontransplanted population (p<0.0001). The majority of lymphomas were diagnosed after the first post-transplant year. Heart-lung transplants showed the highest relative risk (RR 239.5) among different types of organ transplants. In kidney recipients, immunosuppression with cyclosporine did not confer added risk compared with azathioprine/steroid treatment, whereas treatment with FK506 increased the risk approximately twofold. Induction therapy with OKT3 or ATG, but not with anti-IL2 receptor antibodies, increased the risk of lymphoma during the first year. Antirejection therapy with OKT3 or ATG also increased the risk. First-year mortality in renal and heart transplant patients with lymphoma was approximately 40% and 50%, respectively, and showed no improvement in recent years. A pattern of preferential localization to the vicinity of the transplant was noted, and the prognosis of the patient was related to localization. This study highlights the continuing risk for lymphoma with time post-transplantation, the contribution of immunosuppression to increased risk, and continuing poor outcomes in patients with post-transplant lymphoma.
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            Kaposi's sarcoma.

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              Efficacy and safety of valganciclovir vs. oral ganciclovir for prevention of cytomegalovirus disease in solid organ transplant recipients.

              We compared the efficacy and safety of valganciclovir with those of oral ganciclovir in preventing cytomegalovirus (CMV) disease in high-risk seronegative solid organ transplant (SOT) recipients of organs from seropositive donors (D+/R-). In this randomised, prospective, double-blind, double-dummy study, 364 CMV D+/R- patients received valganciclovir 900 mg once daily or oral ganciclovir 1000 mg three times a day (tid) within 10 days of transplant and continued through 100 days. CMV disease, plasma viremia, acute graft rejection, graft loss and safety were analyzed up to 6 and 12 months post-transplant. Endpoint committee-defined CMV disease developed in 12.1% and 15.2% of valganciclovir and ganciclovir patients, respectively, by 6 months, though with a difference in the relative efficacy of valganciclovir and ganciclovir between organs (i.e. an organ type-treatment interaction). By 12 months, respective incidences were 17.2% and 18.4%, and the incidence of investigator-treated CMV disease events was comparable in the valganciclovir (30.5%) and ganciclovir (28.0%) arms. CMV viremia during prophylaxis was significantly lower with valganciclovir (2.9% vs. 10.4%; p=0.001), but was comparable by 12 months (48.5% valganciclovir vs 48.8% ganciclovir). Time-to-onset of CMV disease and to viremia were delayed with valganciclovir; rates of acute allograft rejection were generally lower with valganciclovir. Except for a higher incidence of neutropenia with valganciclovir (8.2%, vs 3.2% ganciclovir) the safety profile was similar for both drugs. Overall, once-daily oral valganciclovir was as clinically effective and well-tolerated as oral ganciclovir tid for CMV prevention in high-risk SOT recipients.
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                Author and article information

                Contributors
                Journal
                Enferm Infecc Microbiol Clin
                Enferm. Infecc. Microbiol. Clin
                Enfermedades Infecciosas Y Microbiologia Clinica
                Elsevier España S.L.
                0213-005X
                1578-1852
                6 January 2009
                October 2007
                6 January 2009
                : 25
                : 8
                : 535-548
                Affiliations
                [a ]Unidad Clínica de Enfermedades Infecciosas. Hospital Universitario Reina Sofía. Córdoba. España
                [b ]Unidad Clínica de Enfermedades Infecciosas. Hospitales Universitarios Virgen del Rocío. Sevilla. España
                Author notes
                [* ]Correspondencia: Dr. J. Torre-Cisneros. UGC de Enfermedades Infecciosas. Hospital Universitario Reina Sofía. Avda. Menéndez Pidal, s/n. 14004 Córdoba. España. julian.torre.sspa@ 123456juntadeandalucia.es
                Article
                S0213-005X(07)74347-1
                10.1157/13109990
                7130329
                17915112
                72e3d447-bac7-41e4-9116-000e1fe9b556
                Copyright © 2007 Elsevier España S.L. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 6 June 2007
                : 13 June 2007
                Categories
                Article

                infección viral,trasplante,citomegalovirus,hepatitis,enfermedad linfoproliferativa postrasplante,viral infection,transplantation,cytomegalovirus,posttrasplant lymphoroliferative disorder

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