Pehlivanoğlu E, Ament M E, Spolidoro J V, Vargas J, Busuttil R, Berquist W E
Department of Pediatrics, Marmara University Faculty of Medicine, Istanbul.
Turk J Pediatr. 1990 Jan-Mar;32(1):3-11.
Twenty-two post-orthotropic liver transplant (OLT) recipients were studied to investigate the clinical, laboratory and histopathological differences between rejection and CMV infection. The mean age at the time of transplantation was five years. Nine of 22 (41%) patients developed positive CMV, CF-IgG and IgM antibody titers and cultures for CMV following surgery, and three (group 1a) developed interstitial pneumonitis. CMV specific inclusion bodies were found in lung and liver biopsies. Two patients in group 1a were treated successfully with DHPG and decreasing immunosuppressive treatment, while the third died. Clinical presentation of rejection episodes were similar in all groups. CMV infected patients (group 1) received more transfusions of blood and blood products than the non-infected patients (group 2). Rejection episodes occurred sooner and more frequently in group 1a than in group 1b (CMV infected-asymptomatic) and group 2 (non-infected). Group 2 received fewer steroid boluses as well as azathioprine and OKT 3. A percutaneous liver biopsy with routine stains helped detect CMV when inclusion bodies were seen. We conclude that culture proven CMV infection is common post-OLT. Severe CMV infection occurred more frequently in those who had received greater doses of immunosuppressive therapy for possible graft rejection. Monitoring CMV infection following OLT is absolutely necessary. After OLT, decreasing the immunosuppressives and using antiviral agents are important in the management of CMV infection.
对22例原位肝移植（OLT）受者进行了研究，以探讨排斥反应与巨细胞病毒（CMV）感染之间的临床、实验室及组织病理学差异。移植时的平均年龄为5岁。22例患者中有9例（41%）术后CMV、CF-IgG和IgM抗体滴度呈阳性，CMV培养阳性，其中3例（1a组）发生间质性肺炎。在肺和肝活检中发现了CMV特异性包涵体。1a组的2例患者经DHPG治疗及减少免疫抑制治疗后成功治愈，而第3例死亡。所有组中排斥反应的临床表现相似。CMV感染患者（1组）比未感染患者（2组）接受了更多的血液及血液制品输血。1a组比1b组（CMV感染但无症状）和2组（未感染）发生排斥反应更早且更频繁。2组接受的类固醇冲击治疗以及硫唑嘌呤和OKT 3较少。当看到包涵体时，经皮肝活检及常规染色有助于检测CMV。我们得出结论，培养证实的CMV感染在OLT后很常见。严重的CMV感染在那些因可能的移植物排斥而接受更大剂量免疫抑制治疗的患者中更频繁发生。OLT后监测CMV感染绝对必要。OLT后，减少免疫抑制剂用量并使用抗病毒药物对CMV感染的管理很重要。
