Murray B M, Subramaniam S
Department of Medicine, Erie County Medical Center, Nephrology Division, 462 Grider Street, Buffalo, NY 14215, USA.
Transpl Infect Dis. 2004 Mar;6(1):3-9. doi: 10.1111/j.1399-3062.2004.00043.x.
The purpose of this study was to retrospectively review our experience with a consecutive group of 41 renal transplant recipients (R) who received a kidney from a cytomegalovirus (CMV) seropositive donor (D(+)) and had 3 months of prophylaxis with oral ganciclovir. Patients were prospectively monitored clinically and with determinations of CMV antigenemia for at least 6 months. Patients were followed for a mean period of 247+/-16 days. CMV antigenemia developed in 51% of patients (53% D(+)R(-), 47% D(+)R(+)) after the transplant, but in no case was antigenemia seen during the period of oral ganciclovir therapy. Antigenemia developed at a median of 167 days post transplant (range 99-522 days) and peak antigen counts ranged from <1-3940, and tended to be higher in D(+)R(-) recipients. Infection was symptomatic in 67% of the antigenemic patients and symptoms tended to be more marked in the D(+)/R(-) than in the D(+)/R(+) group. All symptomatic patients were treated with intravenous ganciclovir (21 days) followed by 9 weeks of oral ganciclovir and responded with resolution of symptoms and antigenemia. No evidence of tissue-invasive disease was seen. Recurrence of antigenemia was observed exclusively in the D(+)R(-) group, occurred with less severe manifestations of CMV infection, and invariably responded to retreatment with ganciclovir. Our results suggest that oral ganciclovir prophylaxis is effective in preventing CMV infection during the 3-month period of prophylaxis, that a 3-month period of prophylaxis appears to be sufficient for D(+)R(+) recipients, but a longer period of oral ganciclovir prophylaxis may be needed in D(+)R(-) recipients. Clinicians caring for renal transplant recipients should be vigilant to the possibility of late CMV infection, especially in D(+)R(-) recipients.
本研究的目的是回顾性分析41例接受巨细胞病毒（CMV）血清学阳性供者（D(+)）肾脏的肾移植受者（R）的经验，这些受者接受了3个月的口服更昔洛韦预防治疗。对患者进行前瞻性临床监测，并至少6个月测定CMV抗原血症。患者平均随访247±16天。移植后51%的患者出现CMV抗原血症（53% D(+)R(-)，47% D(+)R(+)），但在口服更昔洛韦治疗期间未出现抗原血症。抗原血症在移植后中位数167天出现（范围99 - 522天），抗原计数峰值范围为<1 - 3940，且在D(+)R(-)受者中往往更高。67%的抗原血症患者出现感染症状，且D(+)/R(-)组的症状往往比D(+)/R(+)组更明显。所有有症状的患者均接受静脉注射更昔洛韦治疗（21天），随后口服更昔洛韦9周，症状和抗原血症均得到缓解。未发现组织侵袭性疾病的证据。仅在D(+)R(-)组观察到抗原血症复发，复发时CMV感染表现较轻，且再次使用更昔洛韦治疗均有效。我们的结果表明，口服更昔洛韦预防在预防3个月的预防期内的CMV感染是有效的，3个月的预防期对D(+)R(+)受者似乎足够，但D(+)R(-)受者可能需要更长时间的口服更昔洛韦预防。照顾肾移植受者的临床医生应警惕晚期CMV感染的可能性，尤其是在D(+)R(-)受者中。
