Vrtovec B, Thomas C D, Radovancevic R, Frazier O H, Radovancevic B
Department of Cardiopulmonary Transplantation, Texas Heart Institute, Houston, Texas 77225, USA.
J Heart Lung Transplant. 2004 Apr;23(4):461-5. doi: 10.1016/S1053-2498(03)00200-6.
We compared the use of intravenous ganciclovir and cytomegalovirus hyperimmune globulin (CMVIG) as a pre-emptive treatment for cytomegalovirus (CMV)-positive heart transplant recipients.
Of 59 CMV-seropositive adult heart transplant recipients enrolled in Group 1, 37 tested positive for pp65 antigen within 12 weeks post-transplantation. These patients were randomized to receive either intravenous ganciclovir (n = 23) or CMVIG (n = 14). Group 2 included 133 CMV-seropositive heart transplant recipients who were not tested for CMV antigenemia and who received no anti-CMV therapy.
CMV disease developed in 0 of 59 patients from Group 1, and in 27 of 133 patients (20%) in Group 2 (p = 0.0001). The incidence of superinfections was lower in Group 1 (0.28 +/- 0.46) than in Group 2 (1.10 +/- 1.33) (p = 0.01). The 2 groups did not differ with regard to incidence of rejection (0.7 +/- 0.9 in Group 1 vs 1.0 +/- 1.2 in Group 2; p = NS), transplant coronary artery disease at 1 year (14% in Group 1 vs 16% in Group 2; p = NS) or post-transplant lymphoproliferative disease (0% in Group 1 vs 2% in Group 2; p = NS). Ganciclovir and CMVIG therapies were associated with similar rates of rejection (0.52 +/- 0.6 with ganciclovir vs 0.50 +/- 0.60 with CMVIG; p = NS), superinfection (0.30 +/- 0.48 with ganciclovir vs 0.25 +/- 0.46 with CMVIG; p = NS), and transplant coronary artery disease at 1 year (13% with ganciclovir vs 14% with CMVIG, p = NS).
The pre-emptive anti-CMV approach is superior to prophylaxis in CMV-seropositive heart transplant recipients. Both ganciclovir and CMVIG are equally effective.
我们比较了静脉注射更昔洛韦和巨细胞病毒高效价免疫球蛋白（CMVIG）作为对巨细胞病毒（CMV）阳性心脏移植受者的抢先治疗方法的效果。
在纳入第1组的59名CMV血清学阳性成年心脏移植受者中，37名在移植后12周内pp65抗原检测呈阳性。这些患者被随机分为接受静脉注射更昔洛韦（n = 23）或CMVIG（n = 14）治疗。第2组包括133名未进行CMV抗原血症检测且未接受抗CMV治疗的CMV血清学阳性心脏移植受者。
第1组的59名患者中0人发生CMV疾病，第2组的133名患者中有27人（20%）发生CMV疾病（p = 0.0001）。第1组的重叠感染发生率（0.28±0.46）低于第2组（1.10±1.33）（p = 0.01）。两组在排斥反应发生率（第1组为0.7±0.9，第2组为1.0±1.2；p = 无显著差异）、1年时移植冠状动脉疾病发生率（第1组为14%，第2组为16%；p = 无显著差异）或移植后淋巴细胞增生性疾病发生率（第1组为0%，第2组为2%；p = 无显著差异）方面无差异。更昔洛韦和CMVIG治疗的排斥反应发生率（更昔洛韦组为0.52±0.6，CMVIG组为0.50±0.60；p = 无显著差异）、重叠感染发生率（更昔洛韦组为0.30±0.48，CMVIG组为0.25±0.46；p = 无显著差异）以及1年时移植冠状动脉疾病发生率（更昔洛韦组为13%，CMVIG组为14%，p = 无显著差异）相似。
在CMV血清学阳性心脏移植受者中，抢先抗CMV方法优于预防措施。更昔洛韦和CMVIG同样有效。
