CMV management in lung transplant recipients

Abstract

recipients management relative to the mortality and morbidity and, on the other hand, to the availability of effective antiviral agents as well as new diagnostic techniques and the prophylaxis, diagnosis, and treatment of CMV infections. In lung transplant recipients management is evolving with experience and we are living the sunrise of a new personalized or tailored management era matching, almost in real time, infection, diagnosis, immunity status and therapy. KEY WORDS: CMV infection, lung transplant, acute rejection, chronic rejection, hyperimmune globulins. IntroductionCytomegalovirus (CMV), a member of the beta herpes virus group, causes a spectrum of disorders, which includes serious illness in organ transplant recipients (1-4). Its presence in biological specimens and its role in co-infections and rejection is far to be fully defined. It is the second most common infection among lung transplant recipients, after bacterial pneumonia (5, 6), and is associated with significant morbidity and mortality after transplantation. Although the availability of effective antiviral drugs has decreased CMV-related mortality, the attention in last years has been addressed to its immunobiological role: in fact CMV infections or pneumonia have been associated to chronic rejection (bronchiolitis obliterans syndrome, BOS) in some, but not all, studies (7,8). The endothelium represents the anatomical and functional interface between engrafted donor tissue and the host immune system and interacts dynamically in immunomodulation. This implies an important role for the endothelial cell (EC) in the initiation, maintenance and/or termination of immune interactions affecting the fate of allograft (9). CMV does not directly induce HLA class II on infected human EC, but the rejection associated class II induction within the allograft might be a consequence of IFN-gamma release by activated T CD4+ cells in response to CMV infection (10).