Shanahan A, Malani P N, Kaul D R
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, USA.
Transpl Infect Dis. 2009 Dec;11(6):513-8. doi: 10.1111/j.1399-3062.2009.00443.x. Epub 2009 Sep 7.
Efforts to prevent relapsed cytomegalovirus (CMV) disease among solid organ transplant (SOT) recipients present clinical challenges. Historically, SOT recipients treated with short courses of ganciclovir, without documented clearance of viremia, had relapse rates of 23-33%. Current treatment often includes much longer courses of valganciclovir, and persistence of viremia at the end of treatment is rare. We sought to determine the rate and risk factors for relapse under those treatment conditions. Records of 1760 SOT recipients from January 2003 to June 2007 were reviewed; 105 cases of CMV viremia were identified. Relapse occurred in 20/105 (19%); 50% had end-organ disease at the time of relapse. Most patients received approximately 3 months of valganciclovir. Clearance of viremia was documented in 19/20 patients with relapse. Multivariable analysis identified receipt of a thoracic organ and diabetes mellitus as risk factors for relapse. Despite long treatment courses with valganciclovir and documented clearance of viremia, CMV relapse remains common among SOT recipients. Better understanding of the epidemiology of CMV among SOT recipients and validation of risk factors for disease relapse should be the focus of future prospective trials. Such trials should include different treatment durations and extended monitoring for relapse.
预防实体器官移植（SOT）受者巨细胞病毒（CMV）疾病复发的努力面临着临床挑战。从历史上看，接受短疗程更昔洛韦治疗且病毒血症未得到记录清除的SOT受者，其复发率为23% - 33%。目前的治疗通常包括更长疗程的缬更昔洛韦，且治疗结束时病毒血症持续存在的情况很少见。我们试图确定在这些治疗条件下的复发率和危险因素。回顾了2003年1月至2007年6月期间1760名SOT受者的记录；确定了105例CMV病毒血症病例。20/105（19%）发生了复发；50%在复发时有终末器官疾病。大多数患者接受了约3个月的缬更昔洛韦治疗。19/20例复发患者记录了病毒血症清除情况。多变量分析确定接受胸器官移植和糖尿病是复发的危险因素。尽管使用缬更昔洛韦进行了长疗程治疗且记录了病毒血症清除情况，但CMV复发在SOT受者中仍然很常见。更好地了解SOT受者中CMV的流行病学以及验证疾病复发的危险因素应是未来前瞻性试验的重点。此类试验应包括不同的治疗持续时间和对复发的延长监测。
