Schnitzler Mark A
Washington University, 4547 Clayton Avenue, Box 8084, St. Louis, MO 63110, USA.
Am J Health Syst Pharm. 2003 Dec 1;60(23 Suppl 8):S5-8. doi: 10.1093/ajhp/60.suppl_8.S5.
The impact of prophylactic oral ganciclovir therapy on the incidence of cytomegalovirus (CMV) disease, patient and graft survival, and costs in patients receiving kidney and liver transplants is described. CMV disease is a common cause of morbidity and mortality in solid organ transplant recipients unless prophylactic drug therapy is used. Prophylactic oral ganciclovir therapy reduces the incidence of CMV disease in kidney and liver transplant recipients. It is more effective for recipients who are seronegative before the transplant and receive organs from seronegative (D-/R-) donors than in seronegative recipients of organs from seropositive (D+/R-) donors. CMV disease remains a problem in the latter. CMV disease increases the risk of graft failure, which decreases the likelihood of patient survival. The extent of matching of the DR subregion of the human leukocyte antigen complex in the donor and recipient may affect graft survival in patients with CMV disease. Graft failure is costly and should be considered in economic analyses of CMV prophylaxis regimens because of the potential impact of prophylaxis on CMV disease. The use of oral ganciclovir for CMV prophylaxis has reduced the incidence of CMV disease in kidney and liver transplant recipients.
本文描述了预防性口服更昔洛韦治疗对接受肾移植和肝移植患者的巨细胞病毒（CMV）疾病发生率、患者及移植物存活率以及成本的影响。CMV疾病是实体器官移植受者发病和死亡的常见原因，除非采用预防性药物治疗。预防性口服更昔洛韦治疗可降低肾移植和肝移植受者的CMV疾病发生率。对于移植前血清学阴性且接受血清学阴性（D-/R-）供者器官的受者，其效果优于接受血清学阳性（D+/R-）供者器官的血清学阴性受者。CMV疾病在后者中仍然是一个问题。CMV疾病会增加移植物失功的风险，从而降低患者存活的可能性。供者和受者人类白细胞抗原复合体DR亚区的匹配程度可能会影响患有CMV疾病患者的移植物存活。移植物失功成本高昂，在CMV预防方案的经济分析中应予以考虑，因为预防措施对CMV疾病可能产生影响。口服更昔洛韦用于CMV预防已降低了肾移植和肝移植受者的CMV疾病发生率。
