<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1688-0390</journal-id>
<journal-title><![CDATA[Revista Médica del Uruguay]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Méd. Urug.]]></abbrev-journal-title>
<issn>1688-0390</issn>
<publisher>
<publisher-name><![CDATA[Sindicato Médico del Uruguay]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1688-03902025000401206</article-id>
<article-id pub-id-type="doi">10.29193/rmu.41.4.6</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Determinación de un cut-off de carga viral para terapia anticipada en receptores de trasplante hepático con riesgo intermedio para Citomegalovirus]]></article-title>
<article-title xml:lang="en"><![CDATA[Determination of a Viral Load Cut-off for Preemptive Therapy in Liver Transplant Recipients with Intermediate Risk for Cytomegalovirus]]></article-title>
<article-title xml:lang="pt"><![CDATA[Determinación dun cut-off de carga viral para terapia anticipada en receptores de trasplante hepático con risco intermedio para Citomegalovirus]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Prieto]]></surname>
<given-names><![CDATA[Jimena]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Noble]]></surname>
<given-names><![CDATA[Luciana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[López]]></surname>
<given-names><![CDATA[Martín]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Fernández]]></surname>
<given-names><![CDATA[Ana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Torielo]]></surname>
<given-names><![CDATA[Josefina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Medina]]></surname>
<given-names><![CDATA[Julio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Centro Nacional de Trasplante Hepático  ]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad de la República Oriental del Uruguay Facultad de Medicina Unidad Académica de Enfermedades Infecciosas]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Hospital Central de las Fuerzas Armadas  ]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2025</year>
</pub-date>
<volume>41</volume>
<numero>4</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S1688-03902025000401206&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S1688-03902025000401206&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S1688-03902025000401206&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen El citomegalovirus (CMV) constituye una causa importante de morbilidad en receptores de trasplante hepático (TH), especialmente en aquellos con riesgo intermedio, definidos como seropositivos que no reciben inducción con agentes depletores de linfocitos. En este grupo, la estrategia de terapia anticipada basada en monitoreo virológico permite iniciar tratamiento antiviral de forma precoz. Sin embargo, su eficacia depende de establecer un umbral óptimo de carga viral que oriente la intervención. El objetivo de este estudio fue determinar el punto de corte óptimo de carga viral plasmática de CMV para iniciar terapia anticipada en receptores de TH con riesgo intermedio en el Centro Nacional de Trasplante Hepático (CENATH), Montevideo, Uruguay. Se realizó un estudio retrospectivo unicéntrico, que incluyó receptores seropositivos de TH o trasplante hepatorrenal sin uso de timoglobulina, trasplantados entre enero de 2017 y junio de 2024. Se analizaron 173 episodios de viremia en 143 pacientes, mediante PCR cuantitativa en plasma. Se utilizó el análisis ROC y el índice de Youden para determinar el cut-off óptimo. La progresión a enfermedad por CMV se documentó en 3 casos (1,9%), todos con cargas virales &gt;2.595 UI/ml. Los pacientes con enfermedad presentaron cargas significativamente más elevadas (media: 21.800 vs. 1.373 UI/ml; p&lt;0,05). El análisis ROC arrojó un AUC de 0,986 (IC 95%: 0,967&#8211;1,000). El umbral de 2.595 UI/ml presentó una sensibilidad del 100% y especificidad del 86,4%. Este valor mostró un excelente rendimiento para guiar la terapia anticipada, optimizando el uso de antivirales. Una validación prospectiva está en curso.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract Cytomegalovirus (CMV) is an important cause of morbidity in liver transplant (LT) recipients, especially in those at intermediate risk, defined as seropositive patients who do not receive induction with lymphocyte-depleting agents. In this group, the preemptive therapy strategy based on virological monitoring allows for the early initiation of antiviral treatment. However, its effectiveness depends on establishing an optimal viral load threshold to guide intervention. The aim of this study was to determine the optimal plasma CMV viral load cut-off for initiating preemptive therapy in LT recipients at intermediate risk at the National Liver Transplant Center (CENATH), Montevideo, Uruguay. A single-center retrospective study was conducted, including seropositive LT or liver-kidney transplant recipients without the use of thymoglobulin, transplanted between January 2017 and June 2024. A total of 173 viremia episodes in 143 patients were analyzed using quantitative plasma PCR. ROC curve analysis and Youden&#8217;s index were used to determine the optimal cut-off. Progression to CMV disease was documented in 3 cases (1.9%), all with viral loads &gt;2595 IU/ml. Patients with disease presented significantly higher viral loads (mean: 21,800 vs. 1373 IU/ml; p&lt;0.05). ROC analysis yielded an AUC of 0.986 (95% CI: 0.967&#8211;1.000). The threshold of 2595 IU/ml showed a sensitivity of 100% and specificity of 86.4%. This value demonstrated excellent performance for guiding preemptive therapy, optimizing the use of antivirals. A prospective validation is underway.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo O citomegalovírus (CMV) constitui uma causa importante de morbidade em receptores de transplante hepático (TH), especialmente naqueles com risco intermediário, definidos como soropositivos que não recebem indução com agentes depletores de linfócitos. Nesse grupo, a estratégia de terapia antecipada baseada no monitoramento virológico permite iniciar o tratamento antiviral precocemente. No entanto, sua eficácia depende do estabelecimento de um limiar ótimo de carga viral que oriente a intervenção. O objetivo deste estudo foi determinar o ponto de corte ótimo da carga viral plasmática de CMV para iniciar terapia antecipada em receptores de TH com risco intermediário no Centro Nacional de Transplante Hepático (CENATH), Montevidéu, Uruguai. Foi realizado um estudo unicêntrico retrospectivo, que incluiu receptores soropositivos de TH ou transplante hepatorrenal sem uso de timoglobulina, transplantados entre janeiro de 2017 e junho de 2024. Foram analisados 173 episódios de viremia em 143 pacientes, por meio de PCR quantitativo em plasma. Utilizou-se a análise ROC e o índice de Youden para determinar o cut-off ótimo. A progressão para doença por CMV foi documentada em 3 casos (1,9%), todos com cargas virais &gt;2595 UI/ml. Os pacientes com doença apresentaram cargas significativamente mais elevadas (média: 21.800 vs. 1373 UI/ml; p&lt;0,05). A análise ROC mostrou uma AUC de 0,986 (IC 95%: 0,967&#8211;1,000). O limiar de 2595 UI/ml apresentou sensibilidade de 100% e especificidade de 86,4%. Esse valor demonstrou excelente desempenho para orientar a terapia antecipada, otimizando o uso de antivirais. Uma validação prospectiva está em andamento.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Citomegalovirus]]></kwd>
<kwd lng="es"><![CDATA[Trasplante hepático]]></kwd>
<kwd lng="es"><![CDATA[Viremia]]></kwd>
<kwd lng="es"><![CDATA[Terapia anticipada]]></kwd>
<kwd lng="es"><![CDATA[Carga viral]]></kwd>
<kwd lng="es"><![CDATA[Curva ROC]]></kwd>
<kwd lng="en"><![CDATA[Cytomegalovirus]]></kwd>
<kwd lng="en"><![CDATA[Liver transplant]]></kwd>
<kwd lng="en"><![CDATA[Viremia]]></kwd>
<kwd lng="en"><![CDATA[Preemptive therapy]]></kwd>
<kwd lng="en"><![CDATA[Viral load]]></kwd>
<kwd lng="en"><![CDATA[ROC curve]]></kwd>
<kwd lng="pt"><![CDATA[Citomegalovírus]]></kwd>
<kwd lng="pt"><![CDATA[Transplante de fígado]]></kwd>
<kwd lng="pt"><![CDATA[Viremia]]></kwd>
<kwd lng="pt"><![CDATA[Terapia antecipada]]></kwd>
<kwd lng="pt"><![CDATA[Carga viral]]></kwd>
<kwd lng="pt"><![CDATA[Curva ROC]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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