Sakr M, Hassanein T, Gavaler J, Abu-Elmagd K, Fung J, Gordon R, Starzl T, Van Thiel D
Department of Surgery, University of Pittsburgh School of Medicine, Pennsylvania 15261.
Transplantation. 1992 Apr;53(4):786-91. doi: 10.1097/00007890-199204000-00016.
One hundred and forty randomly selected liver transplant recipients were studied before and after primary orthotopic liver transplantation for the presence or absence of CMV enteritis. Following OLTx, 65 patients were treated with cyclosporine A and 75 were treated with FK506. The two groups were similar with regard to the incidence, location, and outcome of their upper gastrointestinal CMV infection. Prior to OLTx, only one patient had evidence of enteric CMV infection. The incidence of CMV enteritis post-OLTx was 27.7% in the CsA-treated group and 20% in the FK-treated group. During the first posttransplant month, no patient in the FK-treated group developed CMV enteritis, compared with 11.5% of the patients who were treated with CsA (P less than 0.05). Gastric CMV was found in over 80% of those positive for any organ in either group. In addition to CMV infection of the upper gastrointestinal tract, clinically evident CMV disease involved more nonenteric organs in the CsA-treated group than in the FK-treated group. In the CsA-treated group, CMV-negative patients had a statistically higher 1-year survival rate (100%) than CMV-positive patients (77.8%) (P less than 0.05). In the FK-treated group, no difference in survival was observed between CMV-positive or CMV-negative cases at 1 year. Of the patients on CsA, 20% received OKT3 for persistent rejection, as compared with 13% in the FK-treated group. The patients receiving both CsA and OKT3 had a higher rate of upper gastrointestinal CMV infection than did FK-treated patients who also received OKT3 therapy (38.5% versus 20%, respectively). Based upon these data, it can be concluded that (1) patients receiving FK have a lower incidence of enteric CMV infection; (2) following OLTx, upper gastrointestinal CMV infection presents later in FK-treated patients; (3) the stomach is the most frequently involved organ in the UGIT; (4) FK-treated liver recipients have less severe enteric CMV infection than do CsA-treated patients; (5) enteric CMV is not a major cause of mortality in liver transplant recipients; and (6) in patients receiving FK, those who require OKT3 therapy do not appear to be at a greater risk for the development of CMV enteritis than those who do not.
对140例随机选择的肝移植受者在原位肝移植前后进行了巨细胞病毒（CMV）肠炎的有无情况研究。肝移植术后，65例患者接受环孢素A治疗，75例患者接受FK506治疗。两组在上消化道CMV感染的发生率、部位及转归方面相似。肝移植术前，仅有1例患者有肠道CMV感染证据。环孢素A治疗组肝移植术后CMV肠炎的发生率为27.7%，FK506治疗组为20%。在移植后的第一个月，FK506治疗组无患者发生CMV肠炎，而环孢素A治疗组有11.5%的患者发生（P<0.05）。两组中任何器官CMV检测阳性的患者，超过80%的患者胃中发现有CMV。除上消化道CMV感染外，临床明显的CMV疾病在环孢素A治疗组累及的非肠道器官比FK506治疗组更多。在环孢素A治疗组，CMV阴性患者1年生存率（100%）在统计学上高于CMV阳性患者（77.8%）（P<0.05）。在FK506治疗组，1年时CMV阳性或阴性病例的生存率无差异。接受环孢素A治疗的患者中，20%因持续性排斥反应接受OKT3治疗，而FK506治疗组这一比例为13%。同时接受环孢素A和OKT3治疗的患者上消化道CMV感染率高于同样接受OKT3治疗的FK506治疗患者（分别为38.5%和20%）。基于这些数据，可以得出以下结论：（1）接受FK506治疗的患者肠道CMV感染发生率较低；（2）肝移植术后，FK506治疗的患者上消化道CMV感染出现较晚；（3）胃是上消化道中最常受累的器官；（4）FK506治疗的肝移植受者肠道CMV感染比环孢素A治疗的患者轻；（5）肠道CMV不是肝移植受者死亡的主要原因；（6）在接受FK506治疗的患者中，需要OKT3治疗的患者发生CMV肠炎的风险似乎并不比不需要者更高。
