Zusammenfassung
Die CMV-Infektion gehört zu den häufigsten und am meisten Ressourcen verbrauchenden Infektionskomplikationen nach Nierentransplantation. Die Durchseuchung ist hoch, das Virus persistiert lebenslang. Unter Immunsuppression kann es zur Reaktivierung kommen, seronegative Empfänger können durch das Transplantat neu infiziert werden. Goldstandard der Diagnostik ist der Nachweis von pp65 in Leukozyten oder der Virus-DNA im Blut, die Serologie dient ausschließlich der Risikostratifizierung des Patienten vor Transplantation. Die CMV-Erkrankung kann heute überwiegend verhindert werden: Die „Prophylaxestrategie“ besteht aus Ganciclovir oder Valganciclovir über 90 bis 100 Tage, bei der „präemptiven Therapie“ (Voraussetzung: engmaschiges CMV-DNA-Monitoring) wird erst bei nachgewiesener Replikation behandelt, vor Auftreten von Symptomen. Eine CMV-Erkrankung kommt nur noch selten vor und muss rasch antiviral, ggf. auch mit Hyperimmunglobulinen behandelt werden.
Abstract
Cytomegalovirus (CMV) infections are among the most frequent and resource consuming infectious complications after renal transplantation. The prevalence of latent infection is high and the virus shows life-long persistence. Immunosuppressive therapy may lead to virus reactivation and seronegative recipients may be infected via transplanted kidneys from a seropositive donor. Detection of pp65 in leukocytes or viral DNA in blood is the diagnostic gold standard and serology can only be used to establish the risk stratification prior to transplantation. Two different strategies aim at protecting the patient from overt disease. The strategy of prophylaxis relies on 90-100 days of ganciclovir or valganciclovir, the“preemptive therapy” uses antiviral treatment only after viral DNA is detected in blood, but ideally before disease occurs. This strategy depends on frequent DNA testing. If CMV disease is diagnosed, rapid antiviral and in some cases also immunoglobulin therapy are mandatory.
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Der Autor erhält wissenschaftliche Projektfinanzierung sowie Vortragshonorare von folgenden Firmen: Amgen GmbH, Hoffmann La Roche AG, Gambro GmbH.
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Girndt, M. Zytomegalievirusinfektion nach Nierentransplantation. Nephrologe 3, 51–62 (2008). https://doi.org/10.1007/s11560-007-0140-9
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DOI: https://doi.org/10.1007/s11560-007-0140-9