Singh Nina
VA Medical Center and University of Pittsburgh, Infectious Disease Section, University Drive C, Pittsburgh, PA 15240, USA. nis5+@pitt.edu
J Clin Virol. 2006 Apr;35(4):474-7. doi: 10.1016/j.jcv.2005.10.014. Epub 2006 Jan 6.
Late-onset CMV disease is being increasingly recognized as a significant post-transplantation complication.
To discern the impact of antiviral prophylactic strategies on the emerging syndrome of late-onset CMV disease in organ transplant recipients.
Review of existing reports and published data relevant to antiviral prophylaxis in organ transplant recipients.
Prevention of CMV using prophylaxis has proven effective and is widely employed in organ transplant recipients. However, late-onset CMV disease is increasingly being recognized as a significant complication in these patients. The more potent the activity of the antiviral drug and the longer duration of prophylaxis, the greater likelihood of late-onset CMV disease. CMV seronegative recipients of seropositive donor allografts appear to be at a uniquely high risk. A higher proportion of patients with late-onset CMV have tissue invasive disease. Late-onset CMV disease in liver transplant recipients conferred an independently higher risk of mortality in the first post-transplant year. Prolonged antiviral therapy may impair the recovery of CMV-specific T-cell responses. Preemptive therapy appears to be less likely to be associated with CMV disease.
Discernment of the pathophysiologic basis of late-onset CMV warrants investigation. Preemptive therapy may be the preferable approach to CMV prophylaxis.
迟发性巨细胞病毒（CMV）疾病日益被认为是一种重要的移植后并发症。
探讨抗病毒预防策略对器官移植受者中迟发性CMV疾病这一新兴综合征的影响。
回顾与器官移植受者抗病毒预防相关的现有报告和已发表数据。
预防性使用抗病毒药物预防CMV已被证明有效，并在器官移植受者中广泛应用。然而，迟发性CMV疾病在这些患者中日益被认为是一种重要并发症。抗病毒药物的活性越强且预防持续时间越长，发生迟发性CMV疾病的可能性就越大。接受血清反应阳性供体同种异体移植的血清反应阴性受者似乎处于特别高的风险中。迟发性CMV患者中组织侵袭性疾病的比例更高。肝移植受者的迟发性CMV疾病在移植后的第一年独立地赋予更高的死亡风险。延长抗病毒治疗可能会损害CMV特异性T细胞反应的恢复。抢先治疗似乎与CMV疾病的关联较小。
识别迟发性CMV的病理生理基础值得研究。抢先治疗可能是CMV预防的更可取方法。
