Profilaxis de la infección por citomegalovirus en el trasplante de páncreas

Abstract

Pancreatic transplantation carries a higher risk of cytomegalovirus (CMV) infection than renal transplantation alone. The management of CMV disease in pancreatic transplantation depends on the risk indicated by the donor's and recipient's serological profiles (CMV IgG) and the use of antibodies as immunosuppressive therapy (especially thymoglobulin). Most clinical guidelines recommend the use of prophylaxis in preference to preemptive therapy in both donor (D)+/recipient (R)- and D+/R+ pancreatic transplantations. In combinations with highest risk (D+/R-), prophylaxis with valganciclovir 900mg per day for 3 to 6 months is recommended, adjusted to renal funtion. In D+/R+ combinations, if antibody therapy was used in the transplant or in rejection, valgancioclovir prophylaxis is also recommended for 1 to 3 months. When prophylaxis is finished, in both cases, viral load determination (quantitative polymerase chain reaction of CMV) or antigenemia should be carried out for the first year. In D-/R-combinations, preemptive therapy can be considered with determinations of viral load or antigenemia at each follow-up visit during the first year. Once prophylaxis has been suspended, special attention should be paid to the development of delayed CMV disease.