CMV infection, diagnosis and antiviral strategies after liver transplantation

Lautenschlager, Irmeli

doi:10.1111/j.1432-2277.2009.00907.x

Cited by 52 publications

(33 citation statements)

References 94 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In presence of active CMV infection, the immunosuppression should be reduced along with instituting specific therapy such as Ganciclovir/Valganciclovir. 74,75 Rejection Acute cellular rejection (ACR) presents with a histological triad of portal tract infiltrates, bile duct injury, and venous endothelialitis, 76 typically biopsy proven acute rejection is treated with pulse intravenous steroid boluses. In many cases, mild to moderated rejection can be treated with increasing the levels of CNI alone.…”

Section: Immunosuppression and CMV Infectionmentioning

confidence: 99%

Current Status of Immunosuppression in Liver Transplantation

Choudhary

Saigal

Shukla

et al. 2013

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

With advancements in immunosuppressive strategies and availability of better immunosuppressive agents, survival rate following liver transplantation has improved significantly in the recent times. Besides improvements in surgical techniques, the most important factor that has contributed to this better outcome is the progress made in the field of immunosuppression. Over the last several years, the trend has changed to tailored immunosuppression with the aim of achieving optimal graft function while avoiding its undesirable side effects. Induction agents are no longer used routinely and the aim is to provide minimal immunosuppression in the maintenance phase. The present review discusses the various types of immunosuppressive agents, their mechanism of action, clinical utility, advantages and disadvantages, and their side effects in short and long-term. It also discusses about tailoring immunosuppression in presence of various situations such as renal dysfunction, metabolic syndrome, hepatitis C recurrence, cytomegalovirus infections and so on. The issue of chronic kidney disease and the available renal sparing immunosuppressive strategies has been particularly stressed upon. Finally, it discusses about the practical aspects of various immunosuppression regimens including drug monitoring. ( J CLIN EXP HEPATOL 2013;3:150-158)

show abstract

Section: Immunosuppression and CMV Infectionmentioning

confidence: 99%

Current Status of Immunosuppression in Liver Transplantation

Choudhary

Saigal

Shukla

et al. 2013

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

show abstract

“…Use of CMV prophylaxis varies with some units favoring it for high-risk recipients only while others use it universally. Two strategies for CMV prophylaxis are available [32] . The more common strategy is oral prophylaxis for all high-risk transplants for three months.…”

Section: CMVmentioning

confidence: 99%

Matching donor to recipient in liver transplantation: Relevance in clinical practice

Reddy¹,

Varghese²,

Venkataraman³

et al. 2013

WJH

View full text Add to dashboard Cite

Achieving optimum outcomes after liver transplantation requires an understanding of the interaction between donor, graft and recipient factors. Within the cohort of patients waiting for a transplant, better matching of the donor organ to the recipient will improve transplant outcomes and benefit the overall waiting list by minimizing graft failure and need for re-transplantation. A PubMed search was conducted to identify published literature investigating the effects of donor factors such as age, gender, ethnicity, viral serology; graft factors such as size and quality, recipient factors such as age, size, gender and transplant factors such as major or minor blood group incompatibility and immunological factors. We also report technical and therapeutic modifications that can be used to manage donor-recipient mismatch identified from literature and the authors' clinical experience. Multiple donor and recipient factors impact graft survival after liver transplantation. Appropriate matching based on donor-organ-recipient variables, modification of surgical technique and innovative peri-transplant strategies can increase the donor pool by utilizing grafts from marginal donors that are traditionally turned down.

show abstract

“…85 The minimum conditions for determination of 'CMV disease' are fever (>38 C, for atleast 2 days within a 4-day period), neutropenia or thrombocytopenia, and the detection of CMV in blood. 86 End-organ disease, e.g., pneumonia, retinitis, nephritis, or central nervous disease is common and requires detection of CMV in tissue examination. CMV pneumonia remains a life-threatening syndrome, which is usually complicated by other pathogens, such as fungal or bacterial co-pathogens.…”

Section: Cytomegalovirusmentioning

confidence: 99%

“…100,101 CMV triggers inflammation in the graft by upregulation of cytokines, MHC antigens and adhesion molecules, and induces various chemokines and growth factors. 86,102 After liver transplantation, CMV increases inflammation in the graft and the expression of class II molecules adhesion molecules critical or T-cell activation. [103][104][105] Despite adequate treatment to resolve viremia, CMV DNA may persist in hepatocytes and bile duct epithelium.…”

Section: Cytomegalovirusmentioning

confidence: 99%

Infections After Orthotopic Liver Transplantation

Pedersen

Seetharam

2014

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

Opportunistic infections are a leading cause of morbidity and mortality after orthotopic liver transplantation. Systemic immunosuppression renders the liver recipient susceptible to de novo infection with bacteria, viruses and fungi post-transplantation as well to reactivation of pre-existing, latent disease. Pathogens are also transmissible via the donor organ. The time from transplantation and degree of immunosuppression may guide the differential diagnosis of potential infectious agents. However, typical systemic signs and symptoms of infection are often absent or blunted after transplant and a high index of suspicion is needed. Invasive procedures are often required to procure tissue for culture and guide antimicrobial therapy. Antimicrobial prophylaxis reduces the incidence of opportunistic infections and is routinely employed in the care of patients after liver transplant. In this review, we survey common bacterial, fungal, and viral infections after orthotopic liver transplantation and highlight recent developments in their diagnosis and management. ( J CLIN EXP HEPATOL 2014;4:347-360) I nfection after orthotopic liver transplantation (OLT) is a major cause of morbidity and mortality. Infection is estimated to occur in upto 80% of organ recipients. Bacterial infections are most frequent (70%), followed by viral (20%) and fungal infections (8%). 1,2,3 In addition to direct effects of infection and end-organ inflammation, pathogens may have a number of indirect effects that result in allograft injury, rejection and opportunistic superinfection.The risk of infection in liver transplant recipients is determined by the intensity of exposure to infectious agents and the overall level of immunosuppression. 4 In addition, conditions attendant to end-stage liver disease in the immediate perioperative period may render a recipient vulnerable to infection and include: neutropenia, deficits in mucocutaneous barrier integrity, presence of necrotic tissue, ischemia, diabetes mellitus, immunomodulating viruses, uremia, and protein-calorie malnutrition. 5 Infectious exposures come from many sources post liver transplant including: de novo (acquired acute) in the recipient, reactivation in the recipient, the donor organ, and nosocomial and time from transplant may provide clues to etiology (Figure 1). The overall level of immunosuppression is dependent upon the dose, duration, and choice of immunosuppression as well as underlying immune deficiencies. 6 Inflammatory responses to invading pathogens are often blunted by immunosuppressive therapy, and as a result, the classic signs or symptoms of infection may be absent. A high index of suspicion is need in the liver recipient, and a low threshold to perform invasive diagnostic procedures is often required. It is critical to identify clinical factors that predispose recipients to infection and much interest centers on identifying risk factors for infection after liver transplant. GENETIC POLYMORPHISMS IN THE INNATE IMMUNE SYSTEMIn addition to clinical factors that promote ...

show abstract

CMV infection, diagnosis and antiviral strategies after liver transplantation

Cited by 52 publications

References 94 publications

Current Status of Immunosuppression in Liver Transplantation

Current Status of Immunosuppression in Liver Transplantation

Matching donor to recipient in liver transplantation: Relevance in clinical practice

Infections After Orthotopic Liver Transplantation

Contact Info

Product

Resources

About