Valentine Vincent G, Weill David, Gupta Meera R, Raper Brad, Laplace Stephanie G, Lombard Gisele A, Bonvillain Ryan W, Taylor David E, Dhillon Gundeep S
Texas Transplant Center, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas 77555-0772, USA.
J Heart Lung Transplant. 2008 Aug;27(8):875-81. doi: 10.1016/j.healun.2008.05.009. Epub 2008 Jun 30.
Universal ganciclovir (GCV) prophylaxis is a strategy aimed at reducing cytomegalovirus (CMV) infection and delaying the development of bronchiolitis obliterans syndrome (BOS). However, the optimal duration of GCV prophylaxis remains unclear. We report our experience with GCV prophylaxis administered indefinitely and its effect on CMV pneumonitis, BOS and survival after lung transplantation (LT).
One hundred fifty-one patients surviving >100 days after LT were analyzed. GCV was given to 130 CMV donor- or recipient-seropositive patients. Data from 90 patients who received indefinite GCV prophylaxis (IND) and 40 patients who discontinued their GCV prophylaxis (STOP) were compared.
CMV pneumonitis occurred in 16%, 8%, 17% and 19% of patients in the D+R+, D-R+, D+R- and D-R- groups, respectively. In the STOP cohort, 15 of 40 patients developed CMV pneumonitis (median time 79 days) after GCV was stopped. Ten of these 15 patients developed BOS (median time 116 days) after discontinuing GCV. The risk of CMV pneumonitis in the STOP cohort was significantly higher when GCV prophylaxis was discontinued within the first year. Cumulative incidence of CMV pneumonitis in the IND and STOP groups at 5 years was 2% and 57%, respectively (p < 0.001). BOS-free survival and survival were similar across both groups.
Indefinite GCV prophylaxis prevents CMV pneumonitis in 98% of LT recipients. Thirty-eight percent of patients discontinuing prophylaxis developed CMV pneumonitis, 50% of whom progressed to BOS within 1 year. Continuing ganciclovir prophylaxis indefinitely after lung transplantation should be considered.
普遍使用更昔洛韦（GCV）预防是一种旨在减少巨细胞病毒（CMV）感染并延缓闭塞性细支气管炎综合征（BOS）发生的策略。然而，GCV预防的最佳持续时间仍不清楚。我们报告了我们对无限期给予GCV预防及其对肺移植（LT）后CMV肺炎、BOS和生存影响的经验。
分析了151例LT后存活超过100天的患者。130例CMV供体或受体血清学阳性患者接受了GCV治疗。比较了90例接受无限期GCV预防（IND）的患者和40例停止GCV预防（STOP）的患者的数据。
D+R+、D-R+、D+R-和D-R-组中分别有16%、8%、17%和19%的患者发生CMV肺炎。在STOP队列中，40例患者中有15例在停止GCV治疗后发生CMV肺炎（中位时间79天）。这15例患者中有10例在停止GCV治疗后发生BOS（中位时间116天）。当在第一年停止GCV预防时，STOP队列中CMV肺炎的风险显著更高。IND组和STOP组5年时CMV肺炎的累积发生率分别为2%和57%（p<0.001）。两组的无BOS生存率和生存率相似。
无限期GCV预防可使98%的LT受者预防CMV肺炎。38%停止预防的患者发生CMV肺炎，其中50%在1年内进展为BOS。肺移植后应考虑无限期持续使用更昔洛韦预防。
