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Cytomegalovirus infection in renal transplantation: clinical aspects, management and the perspectives

机译：肾移植术中巨细胞病毒感染的临床意义，治疗和观点

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Cytomegalovirus infection is one of most frequent infectious complications after renal transplantation, and can be classified as primo-infection, when the transmission occurs through the graft, or reactivation, when the recipient is cytomegalovirus seropositive. After transplantation, cytomegalovirus can appear as an infection, when the patient presents with evidence of viral replication without symptoms or disease, which has two clinical spectra: typical viral syndrome or invasive disease, which is a less common form. Their effects can be classified as direct, while the disease is developed, or indirect, with an increase of acute rejection and chronic allograft dysfunction risks. Diagnosis must be made based on viremia by one of the standardized methods: antigenemia or PCR, which is more sensitive. The risk factors related to infection after transplantation are the serologic matching (positive donor and negative recipient) and anti-lymphocyte antibody drugs. One of the strategies to reduce risk of disease should be chosen for patients at high risk: preemptive treatment or universal prophylaxis. Recent clinical research has described ganciclovir resistance as an emergent problem in management of cytomegalovirus infection. Two types of mutation that cause resistance were described: UL97 (most frequent) and UL54. Today, sophisticated methods of immunologic monitoring to detect specific T-cell clones against cytomegalovirus are used in clinical practice to improve the management of high-risk patients after renal transplantation.
机译：巨细胞病毒感染是肾脏移植后最常见的感染并发症之一，当通过移植物传播时，或当受体为巨细胞病毒血清阳性时会重新激活，可分为原发感染。移植后，巨细胞病毒可表现为感染，当患者出现病毒复制的迹象而无症状或疾病时，有两种临床表现：典型的病毒综合症或侵袭性疾病，这是一种较不常见的形式。随着疾病的发展，它们的作用可分为直接的或间接的，伴随着急性排斥反应和慢性同种异体功能障碍风险的增加。必须根据病毒血症通过以下一种标准化方法进行诊断：抗原血症或PCR，这种方法更为敏感。与移植后感染相关的危险因素是血清学匹配（阳性供体和阴性受体）和抗淋巴细胞抗体药物。对于高风险患者，应选择降低疾病风险的策略之一：抢先治疗或普遍预防。最近的临床研究将更昔洛韦耐药性描述为巨细胞病毒感染管理中的新问题。描述了两种引起耐药性的突变：UL97（最常见）和UL54。如今，在临床实践中，采用复杂的免疫学监测方法来检测针对巨细胞病毒的特定T细胞克隆，以改善肾移植后高危患者的管理。

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