Rostaing L, Crespin A, Icart J, Lloveras J J, Durand D, Martinet O, Didier J
Service de Néphrologie, Unité de Transplantation d'Organes, CHU Rangueil, Toulouse, France.
Transpl Int. 1994;7 Suppl 1:S331-5. doi: 10.1111/j.1432-2277.1994.tb01384.x.
Cytomegalovirus (CMV) infections, either primoinfection or reactivation, remain an important problem in organ transplantation. We therefore designed a prospective study in which pre-transplant CMV-positive renal transplant (RT) patients were randomized to receive for 3 months starting immediately after transplantation either acyclovir or nothing. Between April 1992 and January 1993, 53 cadaveric renal transplantations were performed in our institution. The immunosuppressive regimen included anti-thymoglobulins (ATG), azathioprine, steroids and cyclosporine A. Patients randomized in the acyclovir arm received the drug from day 1 to day 90 (D90) intravenously as long as the creatinine clearance was not above 10 ml/min and per os afterwards (3200 mg/day if the creatinine clearance was above 50 ml/min). CMV viraemia tests were systematically performed every 2 weeks until day 90 or when febrile episodes occurred. The patients were 53 adults who received a RT during the study period; 37 were included in the study of which 19 received acyclovir prophylaxis (group A) and 18, no prophylaxis (group B). The two groups did not significantly differ according to sex ratio, recipient's age, number of CMV-negative donors and number of days on ATG (10.76+/-6.16 vs. 8.28+/-4.21 days). There were significantly fewer viraemia episodes in group A (n = 6) than in group B (n = 13, P < 0.05); nevertheless, the percentage of symptomatic CMV viraemia was the same in both groups (35% vs. 38.5%). The onset of CMV viraemia occurred in the same period in both groups (39+/-13.8 days vs. 34.3+/-15 days; P = NS). The number of rejection episodes in the study period was the same in both groups (8 in each). We conclude from this prospective study that post-RT acyclovir prophylaxis reduces significantly the number of CMV viraemia episodes but does not delay their onset. Furthermore, it has no effect upon the percentage of symptomatic viraemias.
巨细胞病毒（CMV）感染，无论是原发性感染还是再激活，在器官移植中仍然是一个重要问题。因此，我们设计了一项前瞻性研究，将移植前CMV阳性的肾移植（RT）患者随机分为两组，一组在移植后立即接受为期3个月的阿昔洛韦治疗，另一组不接受任何治疗。1992年4月至1993年1月期间，我们机构共进行了53例尸体肾移植手术。免疫抑制方案包括抗胸腺细胞球蛋白（ATG）、硫唑嘌呤、类固醇和环孢素A。随机分配到阿昔洛韦组的患者从第1天至第90天（D90）静脉注射该药物，只要肌酐清除率不高于10 ml/min，之后改为口服（如果肌酐清除率高于50 ml/min，则为3200 mg/天）。每2周系统地进行一次CMV病毒血症检测，直至第90天或出现发热症状。研究期间接受肾移植的53名成年患者中，37名被纳入研究，其中19名接受阿昔洛韦预防治疗（A组），18名未接受预防治疗（B组）。两组在性别比、受者年龄、CMV阴性供体数量和使用ATG的天数方面无显著差异（分别为10.76±6.16天和8.28±4.21天）。A组的病毒血症发作次数（n = 6）明显少于B组（n = 13，P < 0.05）；然而，两组有症状的CMV病毒血症百分比相同（分别为35%和38.5%）。两组CMV病毒血症的发作时间相同（分别为39±13.8天和34.3±15天；P = 无显著性差异）。研究期间两组的排斥反应发作次数相同（均为8次）。我们从这项前瞻性研究中得出结论，肾移植后使用阿昔洛韦预防可显著减少CMV病毒血症发作次数，但不会延迟其发作。此外，它对有症状病毒血症的百分比没有影响。
