Sánchez-Lázaro I J, Almenar L, Martínez-Dolz L, Agüero J, Buendía F, Navarro J, Raso R, Salvador A
Heart Failure and Transplant Unit, Department of Cardiology, La Fe University Hospital, Valencia, Spain.
Transplant Proc. 2010 Oct;42(8):3206-7. doi: 10.1016/j.transproceed.2010.05.128.
After cardiac allograft vasculopathy, tumors are the second leading cause of death among heart transplantation (HT) patients after the first year. Lymphomas are tumors of lymphocytic origin whose development has been associated with the use of anti-CD3 monoclonal antibody (OKT3). Some studies suggest that the use of acyclovir could counteract this effect. Our aim was to investigate the impact of gancyclovir on OKT3 and lymphoma development after HT.
We included all 239 HTs performed in our center from 1989 to 2002. We divided patients into those who received gancyclovir treatment (prophylaxis, pre-emptive therapy, or for cytomegalovirus infection) versus those who did not receive this agent at any time during follow-up (88 vs 151 patients). The statistical methods were Student's t and chi-square tests.
There were no differences in the baseline characteristics of the patients--gender, recipient age, etiology leading to HT, diabetes, and dyslipidemia--except for a higher rate of hypertension among the group who did not receive gancyclovir (73.7 vs 60.2%; P=.03). None of the 7 patients who developed lymphomas during the follow-up received gancyclovir (0 vs 4.6%; P=.040).
Antivirals may have a relevant role to neutralize potential neoplastic effects (especially lymphomas) associated with the use of OKT3 induction therapy.
心脏移植血管病变之后，肿瘤是心脏移植（HT）患者术后第一年之后的第二大死亡原因。淋巴瘤是淋巴细胞起源的肿瘤，其发生与抗CD3单克隆抗体（OKT3）的使用有关。一些研究表明，使用阿昔洛韦可以抵消这种效应。我们的目的是研究更昔洛韦对心脏移植术后OKT3及淋巴瘤发生的影响。
我们纳入了1989年至2002年在我们中心进行的所有239例心脏移植手术。我们将患者分为接受更昔洛韦治疗的患者（预防、抢先治疗或用于巨细胞病毒感染）与随访期间未接受该药物治疗的患者（88例对151例）。统计方法采用学生t检验和卡方检验。
患者的基线特征——性别、受者年龄、导致心脏移植的病因、糖尿病和血脂异常——无差异，但未接受更昔洛韦治疗的组中高血压发生率较高（73.7%对60.2%；P = 0.03）。随访期间发生淋巴瘤的7例患者中，无一例接受更昔洛韦治疗（0对4.6%；P = 0.040）。
抗病毒药物可能在中和与使用OKT3诱导治疗相关的潜在肿瘤效应（尤其是淋巴瘤）方面发挥重要作用。
