Significance of Cytomegalovirus Prophylaxis Strategies and Development of Cancer in Kidney Transplant Recipients

• Published in: Transplantation proceedings Vol. 43; no. 9; pp. 3380 - 3382
• Main Authors: Osorio, J.C, Medina, R.D, Patiño, N, Ricaurte, L, Moreno, L, Lozano, E
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01-11-2011; Elsevier
• Subjects: Antiviral Agents - therapeutic use; Biological and medical sciences; Colombia; Cytomegalovirus - metabolism; Cytomegalovirus Infections - prevention & control; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Ganciclovir - analogs & derivatives; Ganciclovir - therapeutic use; Humans; Immune System; Infectious diseases; Kidney Transplantation - adverse effects; Kidney Transplantation - methods; Medical sciences; Neoplasms - complications; Neoplasms - etiology; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Treatment Outcome; Viral diseases; Viral Load; Opportunistic infection; Herpesviridae; Transplantation; Malignant tumor; Homotransplantation; Betaherpesvirinae; Kidney; Human cytomegalovirus; Infection; Virus; Medicine; Prevention; Treatment; Urinary system; Surgery; Viral disease; Development; Graft; Strategy; Cancer
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2011.09.090

Abstract Cytomegalovirus (CMV) infection is one of the most common complications among kidney transplant recipients; two approaches preventing this complication are currently available: universal prophylaxis (UP) and pre-emptive therapy (PT). Despite some differences, similar effectiveness and safety have been proven in several studies for both strategies. However, Spinner et al compared both treatments in 115 renal transplant recipients showing deaths were more likely to occur in patients who received UP. Most of these deaths (2/4 cases) occurred because malignancies developed. This finding is paradoxical because CMV is considered a potentially oncogenic virus and, therefore, UP (a longer therapy compared with the PT) should not be linked with the emergence of a greater number of tumors. New evidence suggests that changes in host immune response triggered by CMV infection may have a mitigating effect on the development of tumors. It is now known CMV infection produces a clonal expansion of gamma delta T lymphocytes which can elicit an aggressive response against neoplastic cells. Currently, UP is the therapy most frequently used in Colombian transplant centers; however, doses administered vary depending on several clinical and laboratory factors. There are no clinical cohorts treated with PT. Reviewing the impact of different length dosing schemes is important for creating an immune response affecting malignancy development in kidney transplant recipients.