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KMID : 0361120080220020177
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Korean Journal of Transplantation
2008 Volume.22 No. 2 p.177 ~ p.182
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CMV Disease
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Chae Dong-Wan
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Abstract
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Cytomegalovirus, one of β human herpes virus, cause significant morbidity and mortality in the renal transplant patients via direct and indirect effects of viral infection, which is defined as the presence of CMV in the host. CMV disease in renal transplant recipients is the result of direct cytopathic effects of proliferating virus and manifest as CMV syndrome and/or tissue-invasive disease. Indirect effects of CMV infection are caused by the long-term immuological responses of host to existing CMV virus and manifest as increased occurrence of acute rejection, predisposition to opportunistic bacterial, viral or fungal infection, development of lymphoproliferative disease, atheroscrelosis and posttransplantation diabets mellitus and increase in all-cause mortality in renal transplant recipients. Because the development and severity of CMV disease depends on the amount of virus present in renal transplant recipients, the quantitative tests for viral load such as antigenemia assay and molecular amplification of CMV are useful for diagnosis of CMV disease and serve as a guidance in prophylaxis and treatment of CMV disease in renal transplant recipients. CMV prophylaxis is indicated in high-risk patients such as CMV negative recipients of CMV positive donor or CMV positive recipients who have received anti-lymphocyte antibodies as induction therapy or treatment of acute rejection. Universal prophylaxis and pre-emptive treatment using mainly ganciclovir are main strategies and have their own advantages and disadvantages. Recently long-term prophylaxis up to 24 weeks is favored to prevent the occurrence of CMV disease after discontinuation of
prophylaxis. Although intravenous ganciclovir is effective standard treatment of tissue-invasive CMV disease in renal transplant recipients, emergence of ganciclovir-resistant CMV strain as a result of mutation of CMV genes involved in viral metabolism of CMV such as UL97 or UL54 is reported in renal transplant recipients.
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KEYWORD
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Renal transplantation, CMV disease, Quantitative test, Prophylaxis, Treatment
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